Homeless Outreach 2015 Registration
Homeless Outreach Registration
First Name *
Your answer
Last Name *
Your answer
Gender *
Age *
Your answer
Grade (in the upcoming school year) *
Your answer
Phone *
Your answer
Email *
Your answer
Student or Staff? *
What times will you be missing/unavailable?
Your answer
Church Name
Your answer
Church Address
Your answer
Parent/Guardian Name *
Your answer
Parent Address *
Your answer
Parent Phone Number *
Your answer
Parent Email
Your answer
Allergies of student (if any)
Your answer
Parent/Guardian Release Form
I, _______________________________, the parent or legal guardian of ________________________________ do hereby consent to let my child attend the Homeless Outreach 2015 at the Korean Church of Columbus, Ohio, and at various homeless shelters. I hereby release the Korean Church of Columbus and the staff of the Homeless Outreach, of any and all liability in case of accident or illness while participating. I also authorize any medical care deemed necessary by an accredited nurse or physician.

_____________________________________ ___________
Parent/Guardian Signature Date

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