South Gate United Methodist Church Lincoln NE

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High Seas Expedition Exploring the Mighty Love of God July 5-9, 2010 8:30—11:30 a.m (early drop off is available from 8:00—8:30) No Registration Fee (donations are welcomed and appreciated) Please fill out the following pre-registration form for each child age 3 and up.
Child's First Name
Child's Middle Name
Child's Last Name
Your Email Address:
Street Address:
City:
State:
Zip:
Home Phone:
Mobile/Cell Phone:
Child's Last Grade Completed:
Child's Age:
Father's Firstname
Father's Last Name
Father's Phone:
Mother's Firstname
Mother's Last Name
Mother's Phone:
Other Emergency Contact's Firstname
Other Emergency Contact's Last Name
Other Emergency Contact's Phone:
Please list any food allergies:
Please list any other allergies:
Medical conditions that would prevent participation in certain activites:
Home Church:
My Child will arive between 8-8:30 for early drop off:	Yes No
I would like a CD of the VBS Songs ($6.00):	Yes No
Release Notice I grant permission to South Gate United Methodist Church and South Gate Preschool and their subordinates, to use my name and/or photographs for use in South Gate Preschool/South Gate Church publications such as recruiting brochures, newsletters, and magazines and to use my name and/or photographs on display boards, and to use my name and/or photographs in electronic versions of the same publications or on the South Gate United Methodist Church and South Gate Preschool website or other electronic forms or media. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to compensation arising from or related to the use of the photograph. I understand that South Gate United Methodist Church and South Gate Preschool cannot control the unauthorized use by persons other than South Gate United Methodist Church and South Gate Preschool of my image once such image is published. Any claim I may have concerning unauthorized publication of my image must be pursued by me against the unauthorized user. South Gate United Methodist Church and South Gate Preschool disclaims any responsibility for such unauthorized use of my published image.
I am 18 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release:


I am the parent or legal guardian of the above named child. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

Electronic Signature:
Type your full legal name


Image Verification

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High Seas Expedition

Exploring the Mighty Love of God

July 5-9, 2010 8:30—11:30 a.m