2022/2023 ANNUAL CLUBS REGISTRATION
Includes a T-shirt for every student.
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Guardian Information:
Guardian Name: *
Address: *
Mobile Number: *
Email: *
We are new to Bridge Church: *
Required
Person to contact in case of emergency (other than guardians listed above:
Name:
Relationship:
Phone:
Person who brought child(ren) today (if different then guardian listed above):
Name:
Relationship:
Phone:
Child #1
Name: *
Birthdate: *
MM
/
DD
/
YYYY
Grade: *
Male/Female: *
Required
Club Options:
Allergies for Child 1:
Conditions/concerns we should be aware of for Child 1:
T-Shirt Size *
Required
Child #2
Name:
Birthdate:
MM
/
DD
/
YYYY
Grade:
Male/Female:
Club Options for Child 2:
Club Options:
Allergies for Child 2:
Conditions/concerns we should be aware of for Child 2:
T-Shirt Size
Parental Release / Authorization: I understand that children participate in Bridge Church activities, events, and outings at their own risk and I assume responsibility for any accidents or injuries and release Bridge Church from any and all claims or liability. I authorize Bridge Church leaders to administer or gain emergency medical care in the case of an accident, injury or serious illness when I cannot be reached. I understand that any medical expenses incurred are my responsibility as legal guardian. Unless otherwise noted below, I also give Bridge Church and its representatives permission to use and/or publish photographs and/or video containing images of my children.
Guardian First & Last Name giving consent: *
(Photo Opt Out)
Child #3 Name:
Birthdate:
MM
/
DD
/
YYYY
Grade:
Male/Female:
Club Options for Child 3:
Club Options:
Allergies for Child 3:
Conditions/concerns we should be aware of for Child 3:
T-Shirt Size
If more then 3 children need to be registered, please resubmit another form.
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