2005-2006 Children and Youth Registration/Permission Form

Please fully complete this registration form (accurate e-mail addresses help us keep you up to date) and turn it in on or before your child(ren) attend their first event – either Sunday School or Logos!

Parent’s Name(s): ______________________________________ E-mail: ___________________

Address: ________________________________________________________ Zip: ___________

Phone: ____________(h) ___________ (w) ____________(c) Home Church: _______________

Child’s Name: ______________________ Birthdate: __/__/__ Gr: _____ E-mail: ______________

*list any medical concerns/allergies:

Child’s Name: ______________________ Birthdate: __/__/__ Gr: _____ E-mail: ______________

*list any medical concerns/allergies:

Child’s Name: ______________________ Birthdate: __/__/__ Gr: _____ E-mail: ______________

*list any medical concerns/allergies:

Child’s Name: ______________________ Birthdate: __/__/__ Gr: _____ E-mail: ______________

*list any medical concerns/allergies:

Emergency Contact (in case parents can’t be reached):

Name: _________________________________________________ Ph: _____________________

I/we give permission for the children listed on this form to participate fully in the Sunday School or Logos program. These programs may include recreational activities on the church grounds and occasional field trips in church van or other authorized vehicles. You will be informed of any trips off site in advance. In case of emergency, I/we authorize the persons in charge to take measures they feel are in the best interest and welfare of the children. This may include emergency medical care, dental or eye care, as well as hospitalization. Every effort will be made to contact the parent/guardian. I will not hold the church, its staff or persons assisting responsible for expenses incurred. I/we release First Presbyterian Church from any liability.

Signature: ___________________________________________ Date: ___________