2024 Smyrna Kids Participation Form

2024 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.
Do you need to register another child?

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.
Do you need to register another child?

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.
Do you need to register another child?

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 occurring as of and after the date below. By 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
Remind App

This year, we will be utilizing the Remind App for all communication regarding student transportation. Please read the information below carefully.
Initial Each week, in order for your child to ride the bus on Wednesday afternoons, you must let Stacey know via the Remind App by 10 AM that morning. After that time, students will not be allowed to go to the office to call & make changes to their plans and we will not be able to make any changes to the list.

It would be best & we would greatly appreciate if you would let us know on Tuesday nights on Remind if your student plans to ride the bus on Wednesday.
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.
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.
Should be Empty:

2024 Smyrna Kids Participation Form

Transportation Waiver and Release

Remind App

Parent/Guardian's Information

Emergency Contact