Olympian Club Registration 2017-2018
 
Olympian Club Registration 2017-2018
Parent/Guardian Last Name:  * 
Parent/Guardian First Name:  * 
Street Address: * 
City:  * 
State:  * 
Zip:  * 
Home Phone:
Work Phone:
Cell Phone:
Your Email Address  * 
Church You Regularly Attend:
Previous Children's clubs where children have completed work & awards received:
Number of children you are registering for Gopher club (4-K) and/or Olympian Club (1-6 grades)  * 
First Child's Name:  * 
DOB:  * 
Grade:  * 
Gender:  * 
Medical conditions or allergies we should be aware of:
Age Group:  * 
Second Child's Name:
DOB:
Grade:
Gender  * 
Medical conditions or allergies we should be aware of:
Age Group:  * 
Third Child's Name:
DOB:
Grade:
Gender:  * 
Medical conditions or allergies we should be aware of:
Age Group:  * 
Fourth Child's Name:
DOB:
Grade:
Gender:  * 
Medical conditions or allergies we should be aware of:
Age Group:  * 
Fifth Child's Name:
DOB:
Grade:
Gender:  * 
Medical conditions or allergies we should be aware of:
Age Group:  * 
Emergency Contact/Medical Release:
In case of an emergency, I may be reached at (Phone):
Contact the following person if I cannot be reached: Name:
Relationship to child:
Address:
Phone:
Second emergency contact: Name:
Relationship to child:
Address:
Phone:
Do you give permission for FBCGE leadership to administer medical treatment in an emergency after attempts to contact you have been made?  * 
Your preferred physician is Dr.:
Phone:
Your preferred dentist is Dr.:
Phone:
Preferred hospital if transfer is needed:
Photographs and video are occasionally taken during club meetings. Do you give permission for FBCGE to display photographs or video of your child(ren) for promotional use?  * 
Liability Release: I grant permission for my child(ren) to participate in all activities of the Olympian program sponsored by FBCGE of Batavia, OH.
My permission releases the church, its leaders and workers from any responsibility for an injury that may occur during the course of the nightly meeting or special activities.
Your Full Name (signature):
Date:
Please type in the box to the right »  * 
Base Price $
Modifications $
Total $
 
 
Powered by SiteOrganic Giving