2017 FnF Child's Registration

Fun & Friends Child's Registration Form 2017

Register up to four children on this form.

Parent information

* Indicates required field

Last Name - Parent/Guardian *

First Name *

Parent/Guardian Contact Phone *

Email Parent/Guardian *

Last Name - Emergency Contact *

Emergency Contact Phone Number *

First Name - Emergency Contact *

Emergency Contact Relationship to the child *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Our Families "Home Church" select one *

child # 1

Child # 1 Name *

First

Last

Gender *

Grade Entering Sept 2017 *

Child's Birth Date (i.e., MM/DD/YYYY) *

Child's Known Allergies *

Names of friends this child wants to be in the same group with: *

Special Needs/Helpful Information *

Select Group *

The Dance and Drama classes require faithful attendance to be able to participate in the final performance on July 26th.
If classes are full, child will be placed in Explorers.
(Nursery/toddler care available for volunteers and parents that stay for the evening activities)

Child # 2

Child # 2 Name *

First

Last

Gender *

Grade Entering Sept 2017 *

Child's Birth Date (i.e., MM/DD/YYYY) *

Child's Known Allergies *

Names of friends this child wants to be in the same group with: *

Special Needs/Helpful Information *

Select Group *

child # 3

Child # 3 Name *

First

Last

Gender *

Grade Entering Sept 2017 *

Child's Birth Date (i.e., MM/DD/YYYY) *

Child's Known Allergies *

Names of friends this child wants to be in the same group with: *

Special Needs/Helpful Information *

Select Group *

Child # 4

Child # 4 Name *

First

Last

Gender *

Grade Entering Sept 2017 *

Child's Birth Date (i.e., MM/DD/YYYY) *

Child's Known Allergies *

Names of friends this child wants to be in the same group with: *

Special Needs/Helpful Information *

Select Group *

Emergency & photo Release

Signing and submitting this form grants temporary authority to a designated adult to provide and arrange for medical care for a minor in the event of an emergency, where the minor is not accompanied by either parents or legal guardians.

I do hereby state that I have legal custody of the aforementioned Minor(s). I grant my authorization and consent for Beautiful Savior Lutheran Church (BSLC) employees, volunteers, or any other representatives to administer general first aid treatment for any minor injuries or illnesses experienced by the Minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designated Adult to summon any and all professional emergency personnel to attend, transport, and treat the minor as deemed advisable by any Oregon State licensed medical professional or institution. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Designated Adult in the exercise of his or her best judgment upon the advice of any such medical professional. Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless BSLC in the event an injury arises.

I grant BSLC, the right to take photographs of me and my family in connection with Fun and Friends. I authorize BSLC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that BSLC may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above Emergency and Photo Release Policies:

E-Signature: Name and DOB (i.e., "John Doe - 10/23/1957") *

Submit

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