Followers Registration Form
Please fill out the form carefully to register your child(ren) for Followers 2021/2022
1st Child's Name
First Name
Last Name
Gender
Please Select
Male
Female
N/A
Birth Date
Please select a month
January
February
March
April
May
June
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August
September
October
November
December
Month
Please select a day
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Day
Please select a year
2024
2023
2022
2021
2020
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1924
1923
1922
1921
1920
Year
Grade
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies
2nd Child's Name
First Name
Last Name
Gender
Please Select
Male
Female
N/A
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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21
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30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
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1995
1994
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1991
1990
1989
1988
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1986
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1982
1981
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1978
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1952
1951
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1941
1940
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies
3rd Child Name
First Name
Last Name
Gender
Please Select
Male
Female
N/A
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies
Will your child(ren) be riding the bus from the intermediate or primary school to the church? (If so please remember to call the school and have your child(ren) put on the Followers bus list.
Yes, my child(ren) will be riding the bus
No, my child(ren) will not ride the bus, I will transport them
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Information
Parent #1
First Name
Last Name
E-mail
example@example.com
Phone Number
Parent #2
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Emergency Contact
First Name
Last Name
Phone Number
Please enter a valid phone number.
Permission, Media and Medical Release
I give permission for my child to participate in this activity. In the event he/she is injured, I waive and release all rights to any claim for damages against the sponsor or its representatives. I further agree that any claim or dispute arising from or related to this agreement shall be settled by mediation and, if necessary, legally binding arbitration, in accordance with the Rules of the Institute for Christian Conciliation; judgment upon an arbitration award may be entered in any court otherwise having jurisdiction. In the event disciplinary action need to be taken against my child due to inappropriate behavior or misconduct, I understand that any expenses incurred will be the responsibility of the parent or guardian of the child. I grant Hayward Wesleyan Church, its representatives and employees the right to take photographs of me and my property in connection with the above identified subject. I authorize Hayward Wesleyan Church, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Hayward Wesleyan Church may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. In the event my child suffers sudden illness, accident, or injury and neither parents nor guardians can be contacted, I give permission for any emergency treatment that is deemed necessary by a licensed physician.
Parent's Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
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