St. Matthew's Monday Ministries 2009 - 2010

Please fill out the form below to register.

Participant Signup

Child Information
First Name:  
Middle Initial:
Last Name:  
Gender:
Date of Birth:  
Address Line 1:  
Address Line 2:
City:  
State:  
ZipCode:  
School:
Grade in Fall 2009:  
Allergies & Medical Information:  

Parent Information
Mother's Information
First Name:  
Last Name:  
Address Line 1: (if different from child)
Address Line 2:
City:
State:
ZipCode:
Home Phone:  
Cell or Work Phone:*  
*So we can reach you during the day on Monday should we have to cancel choir due to weather, illness, etc.

Father's Information
First Name:  
Last Name:  
Address Line 1: (if different from child)
Address Line 2:
City:
State:
ZipCode:
Home Phone:  
Cell or Work Phone:*  
*So we can reach you during the day on Monday should we have to cancel choir due to weather, illness, etc.

Enroll in the following ministry programs by checking the appropriate item(s):

Sunday Ministries

Wonders of Worship/WOW (ages 3-6)
    
    
    


Monday Ministries









PARENT VOLUNTEERS ARE ALWAYS NEEDED! Can you help?
Check the program ministries below where you would be willing to help. Thank you.

              
                   
            (indicate time commitment: )
Your Initials: 

OTHER INFORMATION ABOUT YOUR CHILD
Musical Background:   (Please indicate number of years)
Private Lessons:
Instrument 1:
Years Studied:
Instrument 2:
Years Studied:

SPECIAL INTERESTS:   (Please Check)
              
SPORTS:
                                  

CONSENT FOR TRANSPORTATION:
I/We give permission for the above named child to be transported during St. Matthew’s children’s events.   Transportation may be by Church van, private vehicle or other conveyance.   I understand that there will be supervision for each trip and that all passengers will be required to comply with church rules for travel.   I also understand that the Church provides no insurance for transportation other than standard liability insurance coverage.   I/We are responsible for transportation to and from any event.
(initial)

CONSENT FOR MEDICAL TREATMENT:
In the event that the child named above is injured and requires the attention of a doctor, I/we consent to the rendering of routine or emergency medical/dental care necessary to preserve the health of our (my) child, including diagnostic, medical and surgical treatment by authorized members of an outpatient or hospital staff or their designees, as deemed appropriate in their professional judgment.   In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent.   I/we also acknowledge that we will be ultimately responsible for the cost of any medical care not reimbursed by the health insurance provider.   I also authorize first aid to be administered as judged to be needed by ministry staff.
(initial)

CONSENT FOR PHOTOGRAPHY:
I/We give permission for photographs or video of the above named child to be taken during St. Matthew’s events.   These images could be used in publication, multimedia presentations, included on the church web pages or stored for the purpose of archiving.   Images used on the web may not indentify my child by name and photographic or video images of my child my not be used for commercial purposes.
(initial)

Parent/Guardian eSignature for Consents:
I/We have read and consent to my/our child’s participation, transportation, medical care and photography.   I/We understand that this consent will apply to all situations present and future, and that a copy of this form is as valid as the original.   This consent is to remain in effect for one year from date signed or written revocation is made.
(initial)

Parent/Guardian eSignature :  
Date:  

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