Kids Digital Registration

DIGITAL REGISTRATION FORM

Please fill out the form below to have your child participate in our activities. Read the WAIVER and MEDICAL RELEASE before submitting the form.

WAIVER: By filling out, digitally signing your name at the end, and submitting this form, you agree to indemnify and hold harmless Sewickley Presbyterian Church (SPC), its staff, volunteers, or anyone affiliated with SPC, from any liability for any accident or injury which may be incurred.

MEDICAL RELEASE: In the event of an accident, injury, or illness, I (parent/guardian below) authorize any and all medical attention necessary to be administered to my child, listed below, under the direction of such medical professionals as the Church determines appropriate under the circumstance.

Child Name *

First

Last

Date & Year of Birth *

Age or Grade Child is entering in the fall *

Three years old
Four years old
Five years old
Kindergarten

Parent/Guardian Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Please list names of those allowed to pick up your child:

Please list any known allergies or put "none"

Does your child carry an Epi Pen?

If yes, please give instructions for usage below:

List any dietary restrictions:

List any activities your child should be restricted from:

If your child has a health issue, please give special instructions if any are needed (such as "my child uses an inhaler").

T-Shirt Size *

Digital Signature *

First

Last

DIGITAL REGISTRATION FORM

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