9800 SE 92nd Avenue • Happy Valley • OR • 97086 • (503) 788-7000
Sunday Service: 9:00 a.m. In-person and Livestream
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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
*
Select One
BSLC
We would be interested in attending BSLC
Another Church
We don't have a home church right now
child # 1
Child # 1 Name
*
First
Last
Gender
*
Select One
Male
Female
Grade Entering Sept 2017
*
Select One
Nursery/Toddler
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
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
*
Select One
Nursery (Babies)
Toddler (2-3 yrs)
Primary (Pre-K - 2nd Grade)
Dance (3rd-6th Grade Only)
Drama (3rd -6th Grade Only)
Explorers (3rd-6th Grade Only)
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
*
Select One
Male
Female
Grade Entering Sept 2017
*
Select One
Nursery/Toddler
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
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
*
Select One
Nursery (Babies)
Toddler (2-3 yrs)
Primary (Pre-K-2nd Grade)
Dance (3rd-6th Grade Only)
Drama (3rd-6th Grade Only)
Explorers (3rd-6th Grade Only)
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 # 3
Child # 3 Name
*
First
Last
[object Object]
Gender
*
Select One
Male
Female
Grade Entering Sept 2017
*
Select One
Nursery/Toddler
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
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
*
Select One
Nursery (Babies)
Toddler (203 yrs)
Primary (Pre-K-2nd Grade)
Dance (3rd-6th Grade Only)
Drama (3rd-6th Grade Only)
Explorers (3rd-6th Grade Only)
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 # 4
Child # 4 Name
*
First
Last
Gender
*
Select One
Male
Female
Grade Entering Sept 2017
*
Select One
Nursery/Toddler
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
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
*
Select One
Nursery (Babies)
Toddler (2-3 yrs)
Primary (Pre-K-2nd Grade)
Dance (3rd-6th Grade Only)
Drama (3rd-6th Grade Only)
Explorers (3rd-6th Grade Only)
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)
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
If you have any questions in regards to this form, click
here
.