2019-20 WAC Registration Form

Child's Name

Grade

Address

Phone

This address will receive a confirmation email

Email Belongs to

Child's Birthday

Mother's Name

Mother's Cell Phone

Father's name

Father's cell Phone

Home Church

Doctor's Name

Doctor's Phone

Allergies

Special Instructions or information about your child

Person (s) Authorized to pick up child

Emergency Contact Name

Relationship

Emergency Contact Phone

T-shirt Size

Youth S Youth M Youth L Adult S Adult M Adult L Adult XL Adult XXL Adult XXXL

Consent to Treat Form

As the parent (or guardian) of the above named attendee, I grant permission for my son or daughter to attend Wakefields Covenant Church’s 2018/19 activities and events and authorize Wakefield Covenant Church and its staff, volunteers, and chaperons, to transport and supervise my child in connection with his or her attendance at the various activities throughout the 2018/19 year.
I do further hereby give, release, absolve, indemnify, and agree to hold harmless, Wakefield Covenant Church, its Board, staff, volunteers, chaperones, and persons transporting my son/daughter to and from the activity and associated activities from any claim arising out of injury to my son or daughter, except to the extent such harm is the result of the gross negligence of Wakefield Covenant Church or such other party seeking to enforce this release.

*Electronic Signature

*By entering my name in the box above, I am providing a digital signature on this form.

2019-20 WAC Registration Form

Description

Please Fix the Following