Rock Solid After School Program Registration
Please read and fill out this form if your child will be participating in the after school program at Solid Rock Baptist church on Wednesdays.
Email *
Child's Gender *
Child's Name (First Last) *
Parent 1 Name (First Last) *
Parent 1 Home Phone Number
Parent 1 Cell Phone Number *
How may we contact Parent 1? *
Parent 2 Name (First Last)
Parent 2 Email Address
Parent 2 Home Phone Number
Parent 2 Cell Phone Number
How may we contact Parent 2? *
In the event of cancellation or emergency, which is best method of contact? *
People who are authorized to pick up your child (include all). *
Address, City, State, Zip *
Child's Birth Date *
Child's Grade *
What school does your child attend? *
List any special needs, medical conditions, or requests? *
List any food allergies. *
I, the undersigned parent or legal guardian, hereby consent to, herein referred to as my child, participating in After School Care, an event sponsored by Solid Rock Baptist Church, Pendleton, IN every Wednesday after school, 2021. I certify that my child is able to participate in the following activities: riding the bus from school to church building, games, dinner, services. If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them below. In the event an emergency occurs, I may be reached at the telephone number(s) listed above. If I cannot be reached, I hereby authorize Solid Rock Baptist Church, to make emergency medical decisions for my child. If there are any activities I do not want my child to be involved in, I have listed them below. I understand and hereby agree to assume all of the risks which may be encountered on said activity, including activities preliminary and subsequent thereto. I do hereby agree to hold Solid Rock Baptist Church, Pendleton, IN and its volunteers and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which my child now has or which may arise in the future in connection with the activity or participation in any other associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Indiana, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto, and the terms of this release are contractual and not a mere recital. *
List any activities you do not want your child to be involved in. (Dinner services, Bible studies, Games, etc.) *
Photography Consent: I give permission for my child to be videotaped or photographed. I understand that the images may be displayed in any church publications, church building, or website, *
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