TrueLight Registration

Student Name *

First

Last

Birth Date *

Gender *

Male Female

Allergies/Medical Issues *

Special Needs *

Security/Custody Issues *

Grade *

Teacher's Last Name *

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 *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship to Student *

Father Mother Guardian

Emergency contact information

Pick Up Information

As the parent or legal guardian of the student mentioned above, I grant permission for my son or daughter to attend the TrueLight Bible Club at Bethany Elementary School.
From time to time, photos or videos may be taken of the club to promote TrueLight Bible Club or document the club's activities. By registering my child, I give permission for my child's photograph or video to be used in such a manner.
By registering my child for TrueLight Bible Club, I do further hereby give, release, absolve, indemnify, and agree to hold harmless, TrueLight Bible Club, its sponsors, trustees, staff, and volunteers 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 TrueLight Bible Club or such other party seeking to enforce this release.

Registration

Student Information

Parent/guardian information

Emergency contact information

Pick Up Information

Sharon church