2024-2025 BLAST Child Registration Form
We are so excited to see your child at Bethesda’s after school program this year! BLAST will be held on Wednesdays following school until 5:30pm. BLAST will begin Wednesday August 21, 2024. Please reach out if you have any questions.
Child's Registration Information
Child's Name
First Name
Last Name
Birthday:
-
Month
-
Day
Year
Date
School attending:
Grade level:
Home Church:
Can have their photo taken and used for church publications:
Please Select
Yes
No
Allergies/Medical Concerns:
Interested in bus pickup option?
Yes
No
I am registering additional child(ren)
Yes
No
Back
Next
Save
Additional Child Registration Form
Child's Name
First Name
Last Name
Birthday:
-
Month
-
Day
Year
Date
Grade level:
School attending:
Home Church:
Can have their photo taken and used for church publications:
Please Select
Yes
No
Allergies or Medical Concerns:
Interested in bus pickup option?
Yes
No
I am registering additional child(ren)
Yes
No
Back
Next
Save
Additional Child Registration form
Birthday:
-
Month
-
Day
Year
Date
Child's Name
First Name
Last Name
Grade level:
School attending:
Home Church:
Can have their photo taken and used for church publications:
Please Select
Yes
No
Allergies or Medical Concerns:
Interested in bus pickup option?
Yes
No
I am registering additional child(ren)
Yes
No
Back
Next
Save
Additional Child Registration Form
Child's Name
First Name
Last Name
Birthday:
-
Month
-
Day
Year
Date
Grade level:
School attending:
Home church:
Can have their photo taken and used for church publications:
Please Select
Yes
No
Allergies or Medical Concerns:
Interested in bus pickup option?
Yes
No
I am registering additional child(ren)
Yes
No
Back
Next
Save
Additonal Child Registration Form
Child's Name
First Name
Last Name
Birthday:
-
Month
-
Day
Year
Date
Grade level:
School Attending:
Home Church:
Can have their photo taken and used for church publication:
Please Select
Yes
No
Allergies or Medical Concerns:
Interested in bus pickup option?
Yes
No
Back
Next
Save
Parent/Guardian Information
Parent one
*
First Name
Last Name
Parent/guardian two
First Name
Last Name
Email 1
example@example.com
Email 2
example@example.com
Phone Number 1
Please enter a valid phone number.
Phone Number 2
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Emergency Contact
First & Last Name
Phone Number
Relationship to child:
Would you like to be contacted about being a volunteer?
Yes
No
Waivers and release for medical attention, photos, and transportation: I expressly assume the risk and legal liability and waiving and releasing all claims for injuries, damages, or loss, which might be sustained as a result of Bethesda Presbyterian transportation services; including but not limited to, vehicle operation and boarding and exiting the vehicle. Vehicle is defined as any automobile that is used as transport for Bethesda programs, including not limited to the church buses, or personal vehicles. I recognize and acknowledge that there are certain risks of physical injury to vehicle passengers, and I voluntarily agree to assume the full risk of any injuries, damages, or loss, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or assigned with receiving transportation services, including but not limited to, injuries, damages and losses arising out of negligent, operation, or supervision of the vehicle. I further agree to waive and relinquish all claims I may have, or accrue to me, against Bethesda Presbyterian Church, including its respective officials, agents, volunteers, and employees (hereinafter collectively referred to as “party”). I do hear by release and forever, discharge the party from any, and all claims for injuries, damages, or loss that I may have, or which may accrue to me, and arising out of, connected with, or in anyway associated with said, transportation services. I give my permission to Bethesda Presbyterian Church to seek medical attention for my child, if necessary while participating in the programs. I understand that all necessary precautions will be taken for my child safety. I will not hold the church is staff, or those supervising liable. I consent to a photo and or video release for church purposes, including but not limited to church publications in print and online. I have read and fully understand the above waivers and release all claims. If I am registering online, my online signature shall substitute for, and have the same legal effect as an original form signature. Signature of Parent or Guardian:
*
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Submit
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