2021 Summer Bible Adventure Registration

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Summer Bible Adventure July 12-16, 2021 9:30am-12:30pm

Child’s First Name *

Nickname if applicable.

Child’s Last Name *

Gender *

Female

Male

Child's Entering Grade *

AS OF FALL 2021

Age 4 (by Sept 1, 2021)

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Other:

Does your child ever have bathroom accidents during the day? *

Yes

T-Shirt Size *

youth x-small (2-4)

youth small (6-8)

youth medium (10-12)

youth large (14-16)

adult small

adult medium

adult large

Parent #1Full Name *

Parent #1 Cell Phone Number *

Parent #1 Email *

Parent #2 Full Name

Parent #2 Phone Number

Parent #2 Email

First Emergency Contact Name and Relationship *

Other than Parents listed above

First Emergency Contact Phone Number *

Second Emergency Contact Name and Relationship

Other than Parents

Second Emergency Contact Phone Number

Does your child have any food allergies and/or dietary restrictions? If yes, please list trigger, reaction and if epipen is needed. *

Does your child have any non-food allergies? If yes, please list trigger, reaction and if epipen is needed. *

Please select one option below *

I give consent for my child to participate fully in sports activities at SBA.

I give consent for my child to participate in sports activities at SBA with some restrictions.

My child is NOT medically cleared by a doctor to participate in sports activities.

If your child has some sports activity restrictions at SBA, please explain below:

Special considerations/anything else you would like us to know about your child? (Special medical conditions, shy, friend attending SBA, etc?)

Would you like to help SBA this year as an adult volunteer? *

Yes for one day during SBA week, please contact me

Yes for a few days during SBA week, please contact me

Yes for the entire week during SBA week, please contact me

Yes, I am available to help in the planning ahead of SBA, please contact me

No, I'm sorry I'm not available this year

Required

Photograph Permisssion *

During SBA, we would like to take images including still photos or live videos of children to display on bulletin boards, church bulletins, local newspapers, the parish website or social media. (no names, addresses or phone numbers would be included with information).

Yes, you may include my child’s picture in any of the above ways.

No, please do NOT include my child’s picture in any of the above ways.

I, the parent, or legal guardian of the participant, do hereby grant permission for my child to participate fully in the St. John the Evangelist Church Summer Bible Adventure and all its activities. In the case of a medical emergency, I hereby give permission to St. John the Evangelist Church Summer Bible Adventure leaders, if I cannot be located in sufficient time at the above emergency number, to take said participant to a doctor or hospital and hereby authorize necessary medical treatment. I fully and completely assume responsibility for all medical bills. In consideration for the use of facilities owned or operated by St. John the Evangelist Church in Hopkinton, MA, the undersigned hereby releases and holds harmless St. John the Evangelist Church, its employees and volunteer workers from any and all claims for injuries and/or damage that may arise out of the use of such facilities by children of the undersigned. *

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