Godly Play Registration
Please fill out this form and click submit.
Parents' Names
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Children's Names & Ages
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Email
*
This address will receive a confirmation email
Home Phone
Cell Phone
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Address
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Emergency Contact & Best Way to Contact (Sundays, 9:00-10:00am)
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Children's Birth Dates
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Children's Grade & School Name
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Is there anything special you would like us to know about your children? Please list any allergies, health concerns and/or special needs.
Are you interested in volunteering?
Please select all that apply.
Storyteller (Teacher)
Volunteer Assistant (as needed)
Annual Classroom Setup/Cleanup
Snacks
Epiphany Pageant
Help plan events for kids & families
MEDICAL RELEASE AND AUTHORIZATION: In consideration of having my/our child participate in the Godly Play program at St. Andrew’s Episcopal Church, I (we), the parent(s)/guardian(s) of my(our) minor child or children listed in this application, hereby release, discharge and/or otherwise indemnify the St. Andrew’s Episcopal Church, its affiliated organizations and sponsors, their employees and associated volunteers and personnel, against any claim by or on behalf of my child as a result of the child’s participation in the program. In case of emergency, I hereby give my consent to have a doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of each assistance and/or treatment. PHOTO RELEASE AND AUTHORIZATION: I (we), the parent(s)/guardian(s) of my (our) minor child or children listed in this registration, do hereby consent and authorize the release, publication, dissemination, distribution, use and/or reproduction of any and all photographs taken of my (our) son/daughter/other relation during his/her participation in the Godly Play program at St. Andrew’s Episcopal Church by any employee, volunteer, or representative of St. Andrew’s Episcopal Church. This release acknowledges that all photographic proofs, digital proofs, digital pictures, photographic negatives, positives, constitute property of St. Andrew’s Episcopal Church and may be used by St. Andrew’s Episcopal Church for any purpose determined at its discretion, without further notice or any compensation to me or my child. I understand that by typing my name and the date below, I am electronically signing this document.
*
Please select all that apply.
I agree
I disagree
Signature (Please type full name & date)
*
Submit
Description
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