Student Information
Name
*
First Name
Last Name
Did your child participate in Church School and Folklore last year?
Yes
No
Birth Date
-
Month
-
Day
Year
Date
School
*
Grade
*
Language
English
Serbian
Russian
Greek
Spanish
Other
Parent Information
Mother
First Name
Last Name
Mother's Phone Number
-
Phone Number
Email
example@example.com
Father
First Name
Last Name
Father's Phone Number
-
Phone Number
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Release Information
In case of emergency, I grant consent to Meeting of Our Lord Church School staff to authorize medical care for my minor child named above.
Family Physician
First Name
Last Name
Dr's Office Phone Number
-
Area Code
Phone Number
Preferred Hospital
Allergies
*
None
Tree nuts
Peanuts
Milk
Eggs
Wheat
Fish
Other
Other Health Concerns
Media Release
I, the parent and/or legal guardian of the Child named below, hereby give Meeting of Our Lord Serbian Orthodox Church (“MOL”), its staff, and legal representatives the irrevocable right to use the Child’s name, photograph, image, audio recording, video recording and likeness (collectively, the “Child’s Image”) in all forms and manner, including but not limited to, publication on MOL-owned property, printmedia, digital media, the Internet, social media sites, media releases and broadcasts, without further notification to me. I understand that MOL can not control unauthorized use of the Child’s Image by persons not associated with MOL once the Child’s Image has been published. I hereby forever waive any right to inspect or approve any publication of theChild’s Image by MOL. I hereby forever release and waive any and all claims I may have or ever have against MOL, its officials, staff, and legal representatives for the use of theChild's Image. I have carefully reviewed and understand the above provisions and agree to be bound by them. I voluntarily and irrevocably give my consent and agree to this release and waiver.
Signature
*
Comments
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