Birthdate *
School *
Please describe any medical, allergy, dietary restrictions we need to be aware of. (Club 345 cannot guarantee the ability to accommodate all dietary restrictions/medical needs/special needs and may need parent/guardian assistance if accommodations are beyond our abilities/training.):
Parent/Guardian #1 Name *
Parent/Guardian #1 Email *
Parent/Guardian #1 Cell Phone *
Parent/Guardian #2 Name
Parent/Guardian #2 Email
Parent/Guardian #2 Cell Phone
Emergency Contact & Phone # (other than parent/guardian) *
List of individuals who are allowed to pick up your child including immediate family. *
Please read the following to your child and have them type their name below that they understand. Club 345 is an after-school club that is a ton of fun, but also has a big purpose. We seek to love God by loving others! We work on mission/service projects together that will bless those in our surrounding communities who are in need. While at Club 345 there will be a snack, games, and often times detailed instructions from our mission partners in order to complete a service project correctly. Club 345 members are expected to listen respectfully so everyone can hear the instructions and take the mission project we are completing seriously and ask for help if they need it. Our caring staff and volunteers are always available to assist in any way so you can feel successful with your service projects. Unfortunately, given the size of our Club 345 spaces and the number of kids who will be attending, we cannot allow running, wrestling, rough-housing, gymnastics, or any other activity we deem dangerous to those around you. We want to keep everyone as safe as possible, so parents will be called to come pick you up if you are repeatedly choosing to not follow Club 345 rules. At Club 345 we also seek to show everyone we are working with respect by being kind, patient, and honest. These are traits we will continue to work on throughout the year but are expected while at Club 345. Please type your name in the space below that you have read and understand what Club 345 is and how you can be a part of it. We can't wait to have you join us!
MEDICAL RELEASE: In the event of accident, injury, or illness, I authorize any and all medical attention necessary to be administered to my child, listed above, under the direction of such medical professionals as the Church determines appropriate under the circumstances. Please print your signature below: *
WAIVER: By sending my child to Sewickley Presbyterian Church (SPC) events, I agree to indemnify and hold harmless Sewickley Presbyterian Church, its staff, volunteers, or anyone affiliated with SPC, from any liability for an accident or injury which may be incurred. Please print your signature below: *
