LOGOS Kingdom Registration 2019-2020
Fall Semester Sept. 4 - Nov. 20 | Spring Semester Jan 15 - Mar 4
First Child
Name
*
First Name
Last Name
Grade
*
1st
2nd
3rd
4th
5th
6th
Birthdate
*
-
Month
-
Day
Year
Date
Age
*
Shirt Size
*
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Interested in participating in Christmas Musical (Dec. 8)
*
Yes
No
Allergies / Special Needs
Second Child
Name
First Name
Last Name
Grade
1st
2nd
3rd
4th
5th
6th
Birthdate
*
-
Month
-
Day
Year
Date
Age
*
Shirt Size
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Interested in participating in Christmas Musical (Dec. 8)
Yes
No
Allergies / Special Needs
Third Child
Name
First Name
Last Name
Grade
1st
2nd
3rd
4th
5th
6th
Birthdate
*
-
Month
-
Day
Year
Date
Age
*
Shirt Size
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Interested in participating in Christmas Musical (Dec. 8)
Yes
No
Allergies / Special Needs
Fourth Child
Name
First Name
Last Name
Grade
1st
2nd
3rd
4th
5th
6th
Birthdate
*
-
Month
-
Day
Year
Date
Age
*
Shirt Size
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Interested in participating in Christmas Musical (Dec. 8)
Yes
No
Allergies / Special Needs
Contact Information
Your Email Address
example@example.com
Child(ren) lives with
*
Mother
Father
Both Parents
Guardian
Child's (Children's) Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Info
Mother's Name
First Name
Last Name
Cell Phone
-
Area Code
Phone Number
Email (for weekly info)
example@example.com
Home Phone
-
Area Code
Phone Number
Father's Info
Father's Name
First Name
Last Name
Cell Phone
-
Area Code
Phone Number
Email (for weekly info)
example@example.com
Home Phone
-
Area Code
Phone Number
Guardian's Info
Guardian's Name
First Name
Last Name
Cell Phone
-
Area Code
Phone Number
Email (for weekly info)
example@example.com
Home Phone
-
Area Code
Phone Number
Legal Jargon
Authorized Adults
The following individuals are lawfully allowed to pick up my child(ren) at the conclusion of LOGOS events. In the event any individual other than those listed below attempts to transport your child(ren) from LOGOS events, the LOGOS director, or designee, will notify a parent/guardian and/or local law enforcement officers.
Names
Emergency Contacts
Please list two emergency contacts in the event we are unable to reach you.
Emergency Contact 1
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Emergency Contact 2
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Authorizations
In the event of an emergency where medical treatment is required, I authorize the LOGOS personnel to take my child to the hospital for emergency care.
*
I Agree
I release Lutie Watkins Memorial United Methodist Church, the church staff, and the LOGOS staff from responsibility in the case of an accident or illness which might occur in connection with the LOGOS program.
*
I Agree
I give permission for my child’s picture to be taken and used in the following locations (check all that apply):
*
In the Local Church
Local Newspaper
Lutie Watkins Memorial UMC Website/Newsletter
LOGOS Website/Newsletter
LOGOS Facebook Page
Please Do Not Use My Child's Picture
I understand that the LOGOS program requires parent participation. I agree to work at least 3 times in the Fall semester and 2 times in the Spring semester to fulfill this requirement.
*
I Agree
Payment
LOGOS Fees are: $130 for the 1st child, $80 for the 2nd child, $55 for the 3rd child, and additional children are free. LOGOS fees may be paid at registration OR broken into 3 installments (1/3 due at registration, 1/3 due Oct. 15, and the balance due Dec. 15). If you need a scholarship, please contact Cloris Tiffin before registering. Children enrolled in LOGOS receive a T-shirt as part of the program, but additional shirts are available for purchase. *If you are interested in enrolling a 4-5 yr. old in PreLogos and the requirements for the program (must be weekly volunteer), please contact Cloris Tiffin (325) 248-4466 or cloristiffin@gmail.com.
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How many Kids are you enrolling in LOGOS?
$
Free
Quantity
0
1
2
3
4
Child T-Shirt (enrolled kids receive 1 shirt free)
$
Free
T-Shirt
Youth S
Youth M
Youth L
Youth XL
Quantity
0
1
2
3
4
Child T-Shirt 2 (enrolled kids receive 1 shirt free)
$
Free
T-Shirt
Youth S
Youth M
Youth L
Youth XL
Quantity
0
1
2
3
4
Enter coupon
Apply
Total
$
0.00
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