Great Adventure Club Registration

Student Name

Grade

Birthdate

T-shirt size

Address

Parent's Name

Parent's Cell Phone

Alternate Parent's Cell Phone

This address will receive a confirmation email

Emergency Contact 1 Name

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Phone number

Anyone else allowed to pick up this child (please list name and cell number)

Please indicate how your child will get home after Great Adventure Club (child will not be allowed to walk home if that is not checked) (you can check more than one)

My child(ren) will be picked up after Great Adventure Club My child(ren) will walk home after Great Adventure Club (if checked they will be allowed to tell us when they are to walk home) My child(ren) are registered with Think Together and they will go back to that program

If you attend church what church do you attend?

Please list any allergies this child has

Please list any special needs

Please list any custody/security issues with this child

The child listed on this form is allowed to attend Great Adventure Club at Baldy View Elementary School every Thursday after school. There will be no clubs on school holidays. Club will run until April 2025. Clubs will run concurrent with the school calendar. I understand that it is my responsibility to pick up my child(ren) at 3:45 pm and failure to do so will jeopardize my child's continued participation. Typing your full name below is considered your signature acknowledging this information.

Photography and Video release: I hereby assign and grant Eleventh Street Baptist Church and Its subsidiaries and successors, and assign the unqualified right to the ownership. use and proceeds of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational and promotional purposes.

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Great Adventure Club Registration

Description

Please Fix the Following