Trinity Kid's Club
Tuesday Evening 6:30-8pm starting September 17th, 2019
Participant name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Age and Grade *
Your answer
Parent/Guardian Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Emergency Contact *
Your answer
Phone Number *
Your answer
Relationship to Child *
Your answer
Allergies or Dietary Concerns *
Your answer
Medical Concerns *
Your answer
Emergency Medical Consent
This is my permission for the leader in charge or designates to make arrangements for qualified medical attention for my child in the event of an emergency without necessity of my prior approval. I understand that I will be notified by the quickest means possible if this authority is exercised. I agree to be responsible for any costs that result from this medical attention.
Emergency Medical Procedure Consent *
Photo Release
Throughout the weeks of Kid's Club I am aware that my child may have their photo taken and I consent to this and permit Trinity United Church to publish and use the photos for display.
Photo Release Consent *
Consent to Participate
I am aware that there are certain risks invovled when participating in some of the Kid's club activities and have full confidence that reasonable precautions will be taken to ensure to ensure the safety and well-being of my child. I grant permission for my child/ward to participate fully in this activity.
Signature and Date *
Your answer
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