24-25 Registration form

2024-2025 Children and Youth Registration Form All Saints' Episcopal Church (509) 943-1169 www.allsaintsrichland.org
ParentGuardians Name
Phone Number
Email
example@example.com
ParentGuardians Name
Phone Number
Email
example@example.com
Preferred Mailing Address
City
Zip Code
First Childs Name
Age
Grade
Birthdate

MonthDayYear
Date
School
Allergies or other necessary health information
Second Childs Name
Age
Grade
Birthdate

MonthDayYear
Date
School
Allergies or other necessary health information
Third Childs Name
Age
Grade
Birthdate

MonthDayYear
Date
School
Allergies or other necessary health information
Fourth Childs Name
Age
Grade
Birthdate

MonthDayYear
Date
School
Allergies or other necessary health information
Fifth Childs Name
Age
Grade
Birthdate

MonthDayYear
Date
School
Allergies or other necessary health information
Sixth Childs Name
Age
Grade
Birthdate

MonthDayYear
Date
School
Allergies or other necessary health information
Medical and Photo Release: The children listed above have permission to participate in activities sponsored by the Parish of All Saints' Episcopal Church, Richland, Washington. These activities will be under the direction and supervision of one or more adult leaders, sponsors, or chaperones approved by the Church. Igive permission for any photographs taken during these activities to be used by All Saints' for promotional purposes, including appearing on the website and social media (we do not identify minors In case of medical emergency, if I/we cannot be reached, permission is hereby given to seek appropriate medical attention for the above children, and to hold harmless All Saints' Parish, staff, adult leaders, or chaperones.
Parent or Guardian signature

Clear
Date

MonthDayYear
Date
This release form will remain in effect for one year from the abovesigned date

Clear
If your child will be at church at any time without you present (such as a babysitting night or youth event) or participate in an event off-site (such as caroling), please complete the emergency information below.

In Case of Emergency We will contact you first using the two phone numbers provided above. Please provide an additional emergency contact person:
Emergency Contact name
Is this a mobile phone?
Is this a mobile phone?
Relationship to child
Medical insurance carried
Name of policy holder
Policy number
Primary doctor
Phone
Other people who may pick up my children
Should be Empty: