FY18 No School Art Field Trip

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Dates: Tuesday, November 6
Time: 12-5pm

Child #1 (first name, last name) *

Age *

Child #2 (first name, last name)

Age of child #2

Parent/Guardian First Name *

If registering a child under 18

Parent/Guardian Last Name *

If registering a child under 18

Will you attend the field trip with your child? *

Yes

Another adult will attend with my child

Address *

City *

State *

Zip *

Contact Phone *

Contact Email *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relationship

Emergency Contact Phone *

Medical Conditions/Learning Disabilities/Other helpful info

If you are registering a child, who may pick up your child from this class?

Release *

As an adult or as a legal guardian of the minor named above, I hereby confirm that I have chosen to participate in the Unity Lutheran Church of Berwyn Awake program, including all planned and arranged activities. I am aware that this program may present risks of personal injury, property loss, or damage to participants. I accept all responsibility for any injury, death, or other loss or damage that may occur to me and/or to the minor as a result of the my or the minor’s participation in the Unity Lutheran Church of Berwyn Awake program. I release Unity Lutheran Church of Berwyn and will indemnify and hold harmless Unity Lutheran Church of Berwyn, its agents, affiliates, and successors from all claims, judgments, and costs, including attorney’s fees, incurred in connection with any action that may be brought as a result of my or the minor’s participation in the Unity Lutheran Church of Berwyn Awake program. I have read the Agreement and Release of Liability. I understand and agree to the terms.

Yes

Required

Photography *

Awake may occasionally take pictures of participants for use in marketing material. I hereby consent to the use of my and/or my dependent's photograph in said marketing materials, including brochures, publications, presentations, and social media. Participants will not be named in these photographs.

Yes

Payment Method *

$10 suggested donation per child (adults are free)

I would like to pay with a credit card (a PayPal invoice will be sent to you)

I would like to mail a check to Unity Lutheran Church, 6720 31st Street, Berwyn 60402

I would like a scholarship

Submit

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