| Adventure Week is open to Completed KG - Completed Grade 5 aged children. Children must have been born on or before 09/01/2020. |
| PARTICIPANT INFO |
| *Participant's First Name: |
|
| *Participant's Last Name: |
|
| *Gender: |
|
*Birthday:
(MM/DD/YYYY) |
|
| *Last Grade Completed: |
|
*Allergies, Medical, & Special Needs:
(Does your child have any allergies, medical concerns, or special needs?) |
|
| *If yes, please explain. If no, please type none.: |
|
| PARENT/GUARDIAN INFO |
| *Parent/Guardian Name: |
|
| *Address: |
|
| *City: |
|
| *State: |
|
| *Zip: |
|
*Cell Phone:
(555-555-5555) |
|
| *Email: |
|
| *Where do you attend church?: |
|
| Please list the church you attend: |
|
| IN ADDITION TO THE PARENT(S)/GUARDIAN(S) LISTED ABOVE, PLEASE PROVIDE INFO FOR AT LEAST ONE EMERGENCY CONTACT. |
| *Emergency Contact Name (1): |
|
*Emergency Contact Phone (1):
(555-555-5555) |
|
| Emergency Contact Name (2): |
|
Emergency Contact Phone (2):
(555-555-5555) |
|
| IN ADDITION TO THE PARENT(S)/GUARDIAN(S) LISTED ABOVE, PLEASE LIST ANY ADULTS WHO ARE AUTHORIZED TO PICK-UP YOUR CHILD. |
Authorized Pick-Up:
(A Photo I.D. will be required at the time of pick-up.) |
|
| PHOTO RELEASE:
Photography and video recording may take place on our campus during activities and events and may be used for Warren Church's promotional purposes and social media. By registering you are giving permission for your child's photo to be used in this way.
*If you would like to opt out of this photography release, you must email kids@warren.church with your child's name, date of birth, and a close-up picture of the child for I.D. purposes. |
| PLEASE READ THE TERMS/CONDITIONS:
Terms/Conditions: I/We, the parents/guardian of the above-named child(ren), hereby give approval for my/our child to participate in Adventure Week at Warren Church. I/We assume all risk and hazards incidental to such participation. I/We hereby grant permission for any church staff or adult volunteer present to obtain necessary medical/dental, or mental health treatment in case of sickness or injury to my child when I/We are not able and agree I/We shall be financially liable for said treatment and agree to indemnify and hold harmless Warren Church, its staff, and volunteers for any such treatment. I/We do verify that the above information is correct and waive, release, absolve, indemnify, and agree to hold harmless Warren Church, its staff and volunteers from any claims, demands, and actions arising out of damage or injury to my/our child while participating. By submitting this registration, you agree to the terms and conditions listed above. |