St. Mary and Archangel Michael Special Needs Ministry Registration Form

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Registration form for participants with special needs in Sunday School and the Angels Monthly Camp Program for people with special needs

Child's Name *

Parent's Name

Parent's Phone Number *

Child's Date of Birth *

YYYY

Child's Diagnosis/Educational Label *

Allergy Information *

Are there any stimulants that bother your child or any activities that are difficult for them to do? *

What are your child's special Interests/strengths? *

What suggestions do you have for us to better serve and understand your child?

My child has my permission to attend St. Mary and Archangel Michael Coptic Orthodox Church MCP and to participate in all activities. I hereby give permission to the church and her servants, if deemed necessary, to order X-rays, routine tests and treatment for my child, and in the event I cannot be reached in an emergency, I hereby give permission to the physician to hospitalize, administer proper treatment, and to order injection and/or anesthesia and/or surgery for my child as named on this application. I understand that as a participant, my child may be photographed or videotaped during normal Camp activities, and these photos/videos may be used in promotional materials. I understand that St. Mary & Archangel Michael Coptic Orthodox Church MCP cannot be responsible for lost or broken items, and that unclaimed items will be donated to charity. I understand, and will comply with, all camp policies and procedures. I also understand, and will comply with, all cancellation policies and procedures. *

Please check that you have read and understand the above waiver

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