Fired-Up Friday Registration
Kids in Kindergarten - Fifth Grade
The First Friday of Every Month
6:30-8:30 PM

Mt. Lebanon Evangelical Presbyterian Church
255 Washington Road
Pittsburgh, PA 15216

Contact us at 412-531-3387 ext. 205 or agardner@mlepc.org

Child's First Name
Your answer
Child's Last Name
Your answer
Grade
Age
Your answer
School
Your answer
Church child attends (if any)
Your answer
Allergies/Concerns
Your answer
Drop-Off and Pick-Up
Every child will be given a unique number at drop-off that must be presented at pick-up. If the person picking up your child does not have or know the number, they must be included on your list of adults permitted to pick-up your child and must provide photo ID.
Please list all adults with permission to pick-up your child from Fired-Up Friday (must have their ID if they do not know the child's number).
Your answer
Parent/Guardian Release
In consideration of my aforementioned child being allowed to participate in Fired-Up Friday (hereinafter the “Church Activity”) sponsored by or participated in by the Mt. Lebanon Evangelical Presbyterian Church, (hereinafter the “Church”) and intending to be legally bound, on behalf of myself and my minor child, I do hereby release and forever discharge the Church, its agents, servants, employees, volunteers, and their successors, from and against any/all claims, actions or suits in law or in equity which I on behalf of myself and my minor child might hereafter have by reason of injuries or damages sustained by myself or my child by participating in the Church Activity or in transit to and from participation in such Church Activity.
I fully agree to the Parent/Guardian Release as stated above.
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