WMBC Student Registration Form
WMBC waiver, medical and photo release form.
Email *
Child/Student Name:
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Child/Student Age:
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Child/Student Birthdate:
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Student Phone:
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Parent/Guardian Name:
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Parent/Guardian Phone:
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Home Address:
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Emergency Contact Name:
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Emergency Contact Phone:
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Doctor Name:
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Doctor Phone:
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Student Health Card #:
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Current medications, Medication allergies, Food Allergies, Chronic/Mental Health Concerns: *
Medical & Liability Waiver:
At WMBC, we take precautions to ensure the safety and health of your child, but in the event of accident or sickness, Waldheim Mennonite Brethren Church, its staff, and its volunteers are hereby released from any liability. In the event that your child requires special medication, x-rays or treatment, the parents/guardians will be notified immediately. By completing this form, I give permission for my child to participate fully in the activities and programs of the Waldheim Mennonite Brethren Church. *
Required
Multi Media Waiver:
I understand that appropriate pictures are taken of various church activities and:

I give my permission to WMBC to use pictures/videos on any publication, advertising or web-site which contain images of my child.

I do NOT give my permission to WMBC to use pictures in any way
                                                                         
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Required
Date:
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Parent or Guardian Signature:
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Submit
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