Terrific Tuesday Registration

Important Notice: Parent/Guardian must complete a registration for each child participating before the event/activity.

Student Name *

First

Last

Birth Date *

Last Completed Grade *

Gender *

Male Female

Allergies/Medical Issues *

Special Needs *

Security/Custody Issues *

Parent/guardian information

Parent/Guardian Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship to Student *

Father Mother Guardian

Parent/Guardian Name (optional) *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship to Student *

Father Mother Guardian

Emergency contact information

Primary Emergency Contact Name *

First

Last

Phone Number *

Secondary Emergency Contact Name *

First

Last

Phone Number *

Pick Up Information

Individuals other than parent/guardian approved to pick up children must show valid drivers license to verify identity.

Permission & Release

Permission to Attend
As the parent (or guardian) of the above-named attendee, I grant permission for my son or daughter to attend Sharon
Baptist Church’s activities and events and authorize Sharon Baptist Church and its chaperons, to transport and
supervise my child in connection with his or her attendance at the various activities.

Photo/Video Release
I give permission for the use of any photos, movies, and audio or video recordings of my child’s activities in connection with Sharon Baptist Church’s student/children's ministry, to be used with Sharon Baptist Church’s approval for educational or religious purposes, media coverage, or for publicity benefiting educational or religious purposes.

Liability Release
I do further hereby give, release, absolve, indemnify, and agree to hold harmless, Sharon Baptist Church, its trustees, staff, volunteers, and persons transporting my son or daughter to and from the activity and associated activities from any claim arising out of injury to my son or daughter, except to the extent such harm is the result of the intentional misconduct of Sharon Baptist Church or such other party seeking to enforce this release.

Parent/Guardian's Full Legal Name indicating permission and release *