Activities Registration

Parent/Guardian:*
First NameLast Name
Address:*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Home Phone:*
Country CodePhone Number
Cell Phone:
Country CodePhone Number
E-mail:*

Parental Consent

I hereby consent to let my child participate in the event: Rock Climbing. It is understood that every precaution will be taken for the safety and well-being of my child, but in the event of accident or sickness, YOUR CHURCH HERE, its staff and its volunteers are hereby released from any liability.
Child's Name of Consent:*
First NameLast Name
Parent's Name:*
First NameLast Name
Date:
MonthDayYearHourMinutesAM/PM Option
By submitting this form, I give consent to YOUR CHURCH HERE of the child above
Signature
Clear
Should be Empty:

Registration Form