KIDS DIGITAL REGISTRATION FORM

Please fill out a separate form for each child. After clicking “submit,” refresh the page to get an additional form. Thank you!

Parent/Guardian Information

Parent/Guardian Name(s) *

Parent/Guardian Email(s)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian Cell Phone (include name if more than 1 number)

Emergency Contact & Phone # (other than parent/guardian)

List of individuals who are allowed to pick up your child including immediate family.

Health & Medical Information

Health Insurance Company & Policy Number

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: *

Child Information

Child Name *

First

Last

Birthdate *

School

Please describe any medical, allergies, dietary restrictions we need to know about:

KIDS DIGITAL REGISTRATION FORM

Parent/Guardian Information

Health & Medical Information

Child Information

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