Totally Terrific Tuesday- Bethany After School
Event Timing: October 2, 9, 16 (1st-2nd grade), Oct. 30, Nov.6, 13 (3rd-6th grade)
Event Address: 100 West Venango, Mercer, PA (next to Pizza Joe's)
Contact us at (724) 662-4340 or nate@bethanymercer.org
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REGISTRATION INFORMATION
Name (First & Last) *
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Grade: *
Teacher's Name: *
Birthday *
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Student's Address *
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Parent's Mobile Phone: *
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Authorized Pick-up *
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Allergy/Dietary/Medical Information *
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Church Affiliation
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Emergency Contact Name *
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Emergency Phone Number *
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LIABILITY RELEASE
I give permission for my child to be transported to and attend Totally Terrific Tuesdays at Bethany Church. I release Bethany Presbyterian Church, as well as employees and volunteers from any and all claims or liability arising out of this participation. In case of emergency involving my child, I understand every effort will be made to contact me. In the event that I cannot be reached, I allow the adult leader to select a medical provider to secure the proper treatment of my child at my expense. This includes hospital visits, injections, and/or medication.
MEDIA RELEASE
I understand that the image and/or voice of my child may be recorded while attending programs and activities with Bethany Church, Mercer, PA. I give my consent to the use of any type of media recording of my child for any editorial and/or promotional material by Bethany Church and/or partnering organizations while attending said programs and activities.
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