Parents Day Out Sign Up!

If registering more than one child, please list each child’s details in the same field. Make sure to clearly identify each child’s date of birth and any medical or allergy information

Child/ Children’s Name *

First NameLast Name

Child/ Children’s Date of Birth *

Any Medical Information We Need To Know About? *

Parent/ Guardians Names *

Parent/ Guardians contact information *

Two Emergency Contacts and Their Contact Information *

Liability Release Form As the parent or guardian of the above referenced child, I hereby give permission for our child to participate in Parents Day Out at St Paul United Methodist Church. I recognize that this is a drop off event that involves snacks, playing games and doing crafts and that there are inherent risks involved. On behalf of my child and on our own behalf, I agree to waive all claims against St Paul UMC and it’s owners, staff and instructors for any liability, loss, cost, damage, medical expense, long-term care or emotional distress arising out of any personal injury, including total disability, paralysis and death, which may occur to any of the children while on the premises of or under the instruction, supervision, or control of St Paul UMC. I hereby testify to my child’s sound health of mind and body and authorize St Paul UMC to seek medical treatment at the nearest medical facility in case of emergency.I have read and understand all the above and agree to the above terms, including the Risk and Waiver of Liability. Initial and Date *

Comments and/or Questions

I understand that in order to be signed up for this event I need to pay in advance. Type Yes *

Please Select which one applies to you!

1 child

$40.00 Quantity

2 Children

$75.00 Quantity

3 children

$100.00 Quantity

4 Children

$125.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay