Clone of SAINTS Homeschool PE Trial Day Registration

SAINTS Homeschool PE - Trial Day Registration

(Limited Locations)
Student's Full Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Date
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian 2 Full Name

First NameLast Name
Parent/Guardian 2 Phone Number
Please enter a valid phone number.
Emergency Contact Name*

First NameRelationship to Child
Emergency Contact Phone Number*
Please enter a valid phone number.
Does the student have any medical conditions or allergies we should be aware of? If yes, please specify.
Does your child have any of the following medical devices? Please check all that apply or choose none

EpiPenInhaler (Asthma)Continous Glucose MonitorInsulin PumpNone of the Above
Choose the location your child would like to attend*
Choose the date your child would like to attend*

MonthDayYear
Date
STATEMENT OF LIABILITY

As the parent/guardian of the above named student, I hearby grant him/her permission to participate in SAINTS of Florida, Inc. (SAINTS) sponsored activities. I release and hold harmless SAINTS and its staff from all liability for mishap or injury to the student named herein from the time of drop off to the time of pick up.

In the event my child has a medical emergency that requires medical/surgical services which require my consent before being applied and I cannot be reached, I hereby authorize, appoint, and empower a SAINTS representative to furnish on my behalf such written or oral authorization as may be required. It is understood the best possible care will be given to my child.

ILLNESS POLICY

I agree to notify SAINTS if my child exhibits any of the following symptoms and that my children will not participate in SAINTS activities until all symptoms have completely subsided.

*Fever
*Sore Throat
*Dry Cough
*Runny Nose (non allergy related)

*Unusual Fatigue
*Shortness of Breath
*Stomach Pain or Gastrointestinal Issues
Signature*
Parent/Guardian Email Address*
example@example.com
Should be Empty:

SAINTS Homeschool PE - Trial Day Registration