2025-2026 Smyrna Kids Participation Form

2025- 2026 Smyrna Kids Participation Form
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Current Grade Level
Does the child named above have any special dietary needs, allergies, medical condition or health problems of which Smyrna Church should be aware?
Please explain in detail.
YesNo

Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Current Grade Level
Does the child named above have any special dietary needs, allergies, medical condition or health problems of which Smyrna Church should be aware?
Please explain in detail.
YesNo

Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Current Grade Level
Does the child named above have any special dietary needs, allergies, medical condition or health problems of which Smyrna Church should be aware?
Please explain in detail.
YesNo

Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Current Grade Level
Does the child named above have any special dietary needs, allergies, medical condition or health problems of which Smyrna Church should be aware?
Please explain in detail.

Transportation Waiver and Release

This Waiver and Release will be valid for all transportation and events occurring as of and after the date below. By initialing and signing below, I acknowledge that:
Initial* I will not hold Smyrna Church, its officers, agents, employees, assigns or anyone acting on its behalf, responsible or liable for injury occurring to the named person in the course of such activities or such travel.

Initial* I hereby accept financial responsibility for personal items lost by the person identified herein.

Initial* I authorize Smyrna Church to transport and to obtain, through a physician of its own choice, any emergency medical care that may become reasonably necessary for the person in the course of such activities/events or such travel, and agree to accept the cost of the transportation and/or treatment by medical personnel or facility.

Initial I accept full responsibility and hereby grant permission for my child/children to travel with Smyrna Community Church.
Signature

Clear
CLASS DOJO

This year, we will be utilizing the Class Dojo App for all communication regarding student transportation. Please read the information below carefully.
To ensure your child can ride the bus on Wednesday afternoons, please inform Stacey via the DOJO App by 8 pm on Tuesday night. Please note that during the school day on Wednesday, students will not be permitted to visit the office to make changes to their plans. Additionally,

Stacey will be unable to make any changes to the list after Tuesday at 8 pm and will not be able to correspond with students or parents otherwise.
I understand and agree to adhere to the rules as stated above. *

Clear
Date*

MonthDayYear
Date

Parent/Guardian's Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

Please provide contact information for another adult we can reach out to in case of emergency.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

2025- 2026 Smyrna Kids Participation Form

Transportation Waiver and Release

CLASS DOJO

Parent/Guardian's Information

Emergency Contact