Participant Name(s):
Gender: Male Female
Date of Birth:
Grade: K 1 2 3 4 5 6
Address:
City: Zip:
Parent/Guardian: Relationship To Child:
Home Phone: Work Phone: Mobile:
Email:
Persons Authorized For Pickup:
Emergency Contact Name:
Emergency Contact Phone:
Allergies/Medical Conditions:
I willingly allow my child to participate in Club Friday. I hereby release Rancho Vista Church and its employees from any and all responsibility and any liability resulting from my child's participation in any aspect of this club. I understand that my child may be photographed and photos may be used for various church-related purposes..
I have read and understand this liability disclaimer: Yes No
