2010-2011 Sunday School Registration

Please read the following statements. you will be asked to agree or disagree with these statements below as you register your child.

MEDICAL RELEASE: In case of emergency, I understand that a reasonable effort will be made to contact me. If I cannot be reached, I hereby give an agent of the FIRST PRESBYTERIAN CHURCH the permission to act in my behalf to seek emergency medical treatment for my child in the event that such treatment is deemed necessary by him. I give permission to any licensed physician selected by this agent to administer such emergency treatment as said physician in his/her judgment deems necessary in the circumstances; and hereby absolve FIRST PRESBYTERIAN CHURCH, its agents and employees from any and all liability resulting from their conformance with these instructions.

MEDIA RELEASE: Photographs and videos may be taken on occasion by the Children's and Music Ministries departments of FIRST PRESBYTERIAN CHURCH to be used in one or all of the following ways: written church promotions, church website, and/or audio-visual presentations. Identifying names will not be used. By saying yes below, you are indicating you give your permission for your child's photo or its likeness to be used in any of the above ways. Thank you for your permission.

* Today's Date
* Child's First Name
* Child's last Name
* Child's Date of Birth
* Where would you like to serve in Children's Ministries this year?
If your child is in Elementary School for 2010-2011, indicate which grade level:
* Parent's Full Name
* Address Where Child Resides
* City
* State
* Zip Code
* Primary Phone
Secondary Phone (Cell/other)
* Email
* Does your child have any allergies
* If yes, please explain:
* Does your child have allergies to drugs/medications? (If yes, please explain)
* Does your child have allergies to any foods? (If yes, please explain)
* Does your child have any medical condition we need to be aware of?

* Medical Release: I have read the above medical release statement and agree with it.
* Media Release: I have read the above Media Release and agree to it
* Signature: by typing your name in the box below, you are indicating you have read and agreed to the above releases.
 
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