Discovery Cove Wednesday Evening Registration

Child's Name

Parent's Name

This address will receive a confirmation email

Phone

Address

Grade

Pre K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

My child has the following allergies, medical concerns, or special learning needs:

Emergency contact if parent cannot be reached. Please include name and phone number.

Photo Release Form

I hereby grant permission for my child/children to be photographed and/or video recorded while participating in activities, programs or events at Antrim BIC Church. It is my understanding that photographs are the sole property of Antrim BIC Church and may be used on our website and in our print publications at our discretion. To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed/videoed subject, parent or legal guardian. By signing this form, you are indicating your understanding, support and approval of photos or videos of your child/children being used by Antrim BIC Church.

Parent Acknowledgement Agree Do Not Agree

Parent Signature

Date

Description

Thank you for registering your child for our Wednesday Evening Programming.

Pre-registration is not required, but is helpful for planning purposes.

Discovery Cove Wednesday Evening Registration

Description

Please Fix the Following