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After School Ministry Registration

Student's Name*
First Last
*
Age*
Grade*
Birthday*
Student's Phone (if applicable)
Student's Name
First Last
Age
Grade
Birthday
Student's Phone (if applicable)
Student's Name
First Last
Age
Grade
Birthday
Student's Phone (if applicable)
Parent's Name*
First Last
Contact Phone*
Email*
Parent's Name
First Last
Contact Phone
Email
Address*
Street Address City State ZIP Code
Home Phone (if applicable)
Emergency Contact*
First Last
Phone*
Allergies/Special Needs
I hereby give my permission for all the students listed above to ride the church van for the After School Ministry. I understand that my children will be under adult supervision. I further understand that in signing this form, I release and hold Wye Bible Church harmless. By signing this form, I release and hold harmless its leadership, employees, and any volunteers from any liability, past or future, fully and completely.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.*
- By checking this box and typing my name below, I am electronically signing my application.
Signature of Parent or Legal Guardian*
First Middle Initial Last