CYF REG

Parent/Guardian Info

Name *

First

Last

Email *

Phone *

Child Info

Name *

First

Last

Name Number

School and Grade *

Phone Number

Email

Please describe any relevant food or environmental allergies

Please describe any other relevant health concerns

Any other children?

Yes
No

Name 2 *

First

Last

Phone Number

Email

School and Grade *

Please describe any relevant food or environmental allergies

Please describe any other relevant health concerns

Any other children?

Yes
No

Name 3 *

First

Last

School and Grade *

Phone Number

Email

Please describe any relevant food or environmental allergies

Please describe any other relevant health concerns

Photo Release

Agents of St. Thomas Episcopal Church may take photos or videos of my child(ren), and use them for internal or external communication. Names of children will not be used in the photo captions.

I have read, and I agree with the above statement *

Yes
No

Medical Release

Medical emergencies at choir are rare, but accidents can happen anywhere. In the event of an emergency, efforts will be made to contact the child(ren)’s parents and emergency contacts.

If they are not available to provide guidance, I hereby authorize the staffpersons of St. Thomas Episcopal Church to do the following if the situation requires it:

Administer emergency first aid including CPR.
Call 911 on behalf of my child(ren).
Transport affected child(ren) to an emergency department.
Authorize emergency medical treatment on behalf of the child.
Any other reasonably appropriate action.

I have read, and I agree with the above statement *

Yes
No

Liability Release

In consideration for participation in the St. Thomas Church Children’s Choir program, I, on behalf of my child or ward, do hereby release, forever discharge and agree to hold harmless St. Thomas Episcopal Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned child-participant that occur while said child is participating in the above-described activity.

Furthermore, I, on behalf of my child-participant hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in all activities involved therein.

I further hereby agree to hold harmless and indemnify St. Thomas Episcopal Church, its directors, employees and agents, for any liability sustained by said participant as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.

I am the parent or legal guardian of this participant, and hereby grant my permission for him or her to participate fully in the above described activities, and hereby authorize medical treatment, including, but not in limitation to, emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I hereby assume all transportation costs.

I have read, and I agree with the above statement *

Yes
No