Wyalusing Presbyterian Church
Sunday School 2020-2021 Registration
Email address *
Liability Release #1: Please thoroughly read and check your agreement. Checking a box will signify your understanding and compliance of the statement. *
Liability Release #2: Please thoroughly read and check your agreement. Checking a box will signify your understanding and compliance of the statement. *
Liability Release #3: Please thoroughly read and check your agreement. Checking a box will signify your understanding and compliance of the statement. *
Name of Child #1 *
Date of Birth for Child #1 *
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Age Group for Child #1 *
Child #1 Medical Considerations and/or Allergies *
Name of Child #2
Date of Birth for Child #2
MM
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DD
/
YYYY
Age Group for Child #2
Child #2 Medical Considerations and/or Allergies
Name of Child #3
Date of Birth for Child #3
MM
/
DD
/
YYYY
Age Group for Child #3
Child #3 Medical Considerations and/or Allergies
Mailing Address *
Contact Number for Parent/Guardian *
Emergency Contact (name and number must be different than above name and number) *
Adult(s) that Child/ren May be Released To (other than those already listed)
Media Release (For pictures and videos ONLY) *
Media Release (For LIVE STREAMING and/or LIVE BROADCASTING) *
Volunteer *
A copy of your responses will be emailed to the address you provided.
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