2020 Fall Registration
Parent/Guardian please fill out the permission form for each child that is attending.
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Student Name *
Grade Entering *
Contact/Emergency Phone Number *
Address *
Email *
Parent/Guardian Name *
Allergies or Health Issues *
My child will *
If answer above is picked up, your child will be picked up by:
My child will be attending (check all that apply):
By signing this, you agree to all of the regulations & guidelines in place as The Center re-opens programming for your child. The child referenced above has my permission to participate in all activities at The Center. I hereby release The Center, and its leaders from any liability in the event of accident or injury to my child. I understand that every effort will be made to contact me in case of an emergency, but in the event that I cannot be reached, I authorize the treatment of this student by qualified medical personnel. By agreeing, I also consent to allowing my child’s picture to be used by The Center. *
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