2018-2019 Pre-EYC Registration Form

Child #1 Name*

First NameLast Name

Child #1 Birthdate*

Date

Child #1 Fall 2018 Grade Level

Child #1 School*

Child #1 School Calendar*

Child #2 Name

First NameLast Name

Child #2 Birthdate

Date

Child #2 Fall 2018 Grade Level

Child #2 School

Child #2 School Calendar

Parent #1 Name*

First NameLast Name

Parent #2 Name

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent #1 Phone Number*

Area CodePhone Number

Parent #2 Phone Number

Area CodePhone Number

E-mail*

Child's Insurance Company

Child's Insurance Company Policy Number

Allergies/Food Concerns? (indicate which child and allergy/concern)

I am giving permission for pictures of my child(ren) that are taken at church events/classes to appear on the church website. No Names will be included. If you do not want pictures of your child on the website, please contact Christine.ingram@stpaulscary.org

YesNo

As the parent/legal guardian of the child listed above, I do hereby give my permission for my child to participate in activities with the St. Paul’s Pre-EYC Group and Sunday School classes. I do hereby hold harmless and release St. Paul’s Episcopal Church, Cary, and all adult volunteers and employees from any liability in the event of any accident, injury, or loss of personal property involving my child during Pre-EYC activities. In the event of a medical emergency, I understand that every reasonable effort will be made to contact me at the phone numbers listed below. In the event that I am unable to make arrangements for emergency medical treatment for my child, I authorize any adult volunteer or parish employee associated with the Sunday School or Pre-EYC Group activity to consent to all necessary medical care in my absence. I also understand that payment for such services is my responsibility as the parent/legal guardian.

Yes, I agreeNo, I do not agree

I have discussed the following information with my child and my child agrees that he/she: 1. will not use,possess, or be under the influence of alcohol, tobacco products or illegal drugs during any youth event. 2. will not bring any weapons to any youth event, or engage in sexual conduct, contact, or behavior during any youth event. 3. will remain with the group or in the designated areas and will not show disrespect to fellow participants, adult volunteers, St. Paul’s parishioners or people with whom they come into contact during a youth event. 4. will show respect for the property of others as well as facilities of St. Paul’s and other host locations. 5. My child understands that violation of any of these expectations will result in the contact of his/her parents and a trip home at his/her family’s expense, if necessary.

Yes, I have spoken to my child and my child agrees to these standards

St. Paul's 2018-2019 Pre-EYC Registration Form