Homeless Outreach 2017 Registration
(1) Fill out this form, (2) Before clicking 'Submit' on bottom of the page, PRINT this form using your browser's print option, (3) Submit the form, (4) Have your parent sign the printed form and bring it with you to Homeless Outreach 2017. That's it!
First Name *
Your answer
Last Name *
Your answer
Student or Staff? *
Those entering 8th-12th grade are considered students. Those older are staff.
Gender *
Age *
Your answer
Grade (in the upcoming school year) *
Type "N/A" if staff
Your answer
Phone *
Your answer
Email *
Your answer
Full-Time or Part-Time? *
If Part-Time, what hours/days will you be missing/unavailable to attend?
Your answer
Church Name
Your answer
Church Address
Your answer
Parent/Guardian Name *
Type "N/A" if staff
Your answer
Parent Address *
Type "N/A" if staff
Your answer
Parent Phone Number *
Type "N/A" if staff
Your answer
Parent Email *
Type "N/A" if staff
Your answer
ANY allergies
Your answer
Any questions or comments
Your answer
Parent/Guardian Release Form
I, _______________________________, the parent or legal guardian of ________________________________ do hereby consent to let my child attend the Homeless Outreach 2017 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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