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  • ALIVE Registration Form 2010 11

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    mjburnsy
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    This document is a registration form for a children and youth program called ALIVE for the 2010-2011 year. It collects information such as the child's name, contact information for parents/guardians, home church, medical information, insurance details, and emergency contact. The form also includes permission for adult leaders to seek medical attention in emergencies and for photographs of the child to be taken for church use.

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    This document is a registration form for a children and youth program called ALIVE for the 2010-2011 year. It collects information such as the child's name, contact information for parents/guardians, home church, medical information, insurance details, and emergency contact. The form also includes permission for adult leaders to seek medical attention in emergencies and for photographs of the child to be taken for church use.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    20 views1 page

    ALIVE Registration Form 2010 11

    Uploaded by

    mjburnsy
    This document is a registration form for a children and youth program called ALIVE for the 2010-2011 year. It collects information such as the child's name, contact information for parents/guardians, home church, medical information, insurance details, and emergency contact. The form also includes permission for adult leaders to seek medical attention in emergencies and for photographs of the child to be taken for church use.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
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    ALIVE! Registration Form ALIVE!

    Registration Form
    2010 - 2011 2010 - 2011
    * All children & youth, Kindergarten through 12th grade, are welcome to participate. * * All children & youth, Kindergarten through 12th grade, are welcome to participate. *

    Child’s Name ________________________________________________ Child’s Name ________________________________________________


    Parent/Guardian Name(s) _______________________________________ Parent/Guardian Name(s) _______________________________________
    Address _____________________________________________________ Address _____________________________________________________
    City ______________________ State _____ Zip Code _______________ City ______________________ State _____ Zip Code _______________
    Home Phone __________________ Work Phone _____________________ Home Phone __________________ Work Phone _____________________
    Cell Phone _________________ Email Address ______________________ Cell Phone _________________ Email Address ______________________

    Home Church ________________________________________________ Home Church ________________________________________________


    Child’s Birth date _____________________________________________ Child’s Birth date _____________________________________________
    School grade _________________________________________________ School grade _________________________________________________

    Allergies/Medical Information _____________________________________ Allergies/Medical Information _____________________________________


    ______________________________________________________________ ______________________________________________________________
    Name of Emergency Contact ___________________ Phone _____________ Name of Emergency Contact ___________________ Phone _____________

    Insurance Company __________________________________________ Insurance Company __________________________________________


    Policy # ___________________________________________________ Policy # ___________________________________________________
    Date ______________________________________________________ Date ______________________________________________________

    I give permission for any of the adult ALIVE leaders to seek and obtain I give permission for any of the adult ALIVE leaders to seek and obtain
    medical attention for my son/daughter in the event of an emergency. medical attention for my son/daughter in the event of an emergency.

    Parent/Guardian Signature _______________________________________ Parent/Guardian Signature _______________________________________

    I grant permission for photographs of my child to be taken for church use. I grant permission for photographs of my child to be taken for church use.
    Please note that occasional photos may be included on the church website, but Please note that occasional photos may be included on the church website, but
    no personal information will be included. no personal information will be included.
    Parent/Guardian Signature ______________________________________ Parent/Guardian Signature ______________________________________

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