Freedom Road Bible Church - OlympiansRegistration

Please fill in all of the information below to register your child in the Olympians Club at Freedom Road Bible Church! One Registration Form is required for each child attending. Thank you!

2019-2020 Olympians Registration

Child's Name:*

Parent(s)/Guardian Name:*

Full Mailing Address:*

Date of Birth:

Grade as of September 1 2019:*

Home Phone:*

Cell Phone:*

Email Address:*

Home Church:

Emergency Contact:*

Siblings also attending Olympians:

Please indicate the names of those allowed to pick up your child from Olympians:*

Family Physician:*

Physician Phone:*

Specific medical allergies chronic illnesses or other conditions:*

Date of last tetanus shot:*

To better help our teachers serve your child are there any learning needs that you wish to share?

Comment:

MEDICAL RELEASE: As the parent/guardian I do herewith authorize treatment under the direction of any licensed physician of the following minor in the event of a medical emergency. This authority is granted after a reasonable effort has been made to reach the parent/guardian by phone at the number(s) listed above. The undersigned assumes the responsibility for any costs connected with such treatment and hereby releases Freedom Road Bible Church from any liability therefore. This release form is completed and signed with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.

Signature of Parent/Guardian*

PHOTOGRAPHY RELEASE: Photographs are sometimes taken of children's ministry activities for publicity and promotional purposes which include but are not limited to: in-house presentations church web site FRBC AWANA Facebook page brochures and newsletters. Children's names or information are NEVER used without specific permission. By signing this area you are releasing Freedom Road Bible Church to use photographs of your child as stated above.

Signature of Parent/Guardian*

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