All Saints Church School Registration Form

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All Saints Church School Registration Form

For registering students Pre-K through 5th Grade in the 2018-2019 All Saints Church School

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Email *

New or Returning Students (or both?) *

New Student(s)

Returning Student(s)

Both New & Returning Students

Required

Mother's Name *

First & Last Name; Address; Phone Number

Father's Information *

First & Last Name; Address (if different than above); Phone Number

Primary Address for Child(ren) *

If same as one or both parents, please state "Same as ____"

Info - Student # 1 *

First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher

Info - Student # 2 (if applicable)

First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher

Info - Student # 3 (if applicable)

First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher

Info - Student # 4 (if applicable)

First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher

Info - Student # 5 (if applicable)

First & Last Name; Date of Birth; Grade in School; any allergies, or other notes to teacher

Parent Participation & Authorization *

This form is for the purpose of enrolling a FAMILY into the All Saints Church School for this year (2018-19). Do you agree to do your best to ensure that your family regularly attends the Divine Services & Church School and strives to live an Orthodox Christian life at home?

Permission/Waiver for All Saints Church School *

Acceptance of these permission/waver stipulations are required to participate in the All Saints Church School. Your clicking of this checkbox is your confirmation that you have read, understand, and will abide by them.

Functions and Activities: I understand that participating in the children and youth programs of All Saints Orthodox Church is a privilege. I acknowledge that there are certain risks associated with the activities, including, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death. I acknowledge that there may also be other risks inherent in these activities of which I may not be presently aware.

Release of Liability: By signing this Permission/Waiver Form, I grant permission for the child(ren) named above to participate in any of the activities discussed above. I also expressly assume all risks of the child(ren) participating in the activities. I further release All Saints Orthodox Church and its clergy, leaders, staff, employees, or volunteers, from any claim that I or my child(ren) may have against them as a result of injury or illness incurred during the course of participation in the activities. I further agree to indemnify and hold harmless All Saints Orthodox Church and its clergy, leaders, staff, employees, or volunteers from any and all claims arising from my participation in its activities and programs, or as a result of injury/illness of my child(ren) during such activities.

First Aid and Emergency Medical Treatment: I recognize that there may be occasions where the child(ren) named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of All Saints Orthodox Church to seek and secure any needed medical attention or treatment for the child(ren) named above, including hospitalization, if in the agent's opinion such need arises. In doing so I agree to pay all fees and costs arising from this action to obtain medical treatment. I also give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment.

Special Events and Field Trips: I understand that the child(ren) named above will be participating in All Saints Orthodox Church’s Parish Education Program and that during this period my child(ren) may take part in activities consistent with the purposes of the Church.

Required

Publicity *

Please indicate whether or not you GRANT All Saints permission to use/publish any photo images, video or other media of your childre participating for the purspose of promoting the Church School in print or online.

I hereby GRANT All Saints Orthodox Church permission to use photographic images, videos, or other media of the above listed participant(s) for the purpose of promoting the Church School in print or online. I agree that the images and/or videos become the exclusive property of All Saints Orthodox Church and waive the rights thereto.

I DO NOT GRANT All Saints Orthodox Church permission to publish any photo images or videos of my child participating in the Church School Program.

Required

Family Health Insurance Information *

Insurance Company, Policy Number, & Insurance Company Phone Number

Pediatrician/Primary Care Physician's Information *

Please indicate your child(ren)'s Doctor's Name & Phone Number

Emergency Contacts *

Please provide the names & telephone number of those to call in case of emergency if you are not reachable.

Medical History *

Any Special medical needs or concerns (Allergies, Conditions, Dietary Needs, Medications, etc.)?

Any other helpful information about your child? *

I represent that I am the parent and/or legal guardian of the above named child(ren) who is/are under 18 years of age. I have read the above form and am fully familiar with its contents including the Permission/Waiver section and the Release of Liability section. I give permission for the child(ren) named above to participate in the activities of All Saints Orthodox Church including any special events/activities. I hereby allow the participation of my child(ren) in the activities of All Saints Orthodox Church. By checking "I agree" in the checkbox below, I provide my consent to the Permission/Waiver section of this form, including the Release of Liability above, on behalf of my child, and agree that this Permission/Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns. Additionally, by by submitting this form you hereby agree to accept the above terms. *

I agree.

Required

I agree to remit the $20 fee per student (with a cap of $50 per family) on or before the date of the Church School Social (in 2018: Sep 9th) *

Please mail payment to All Saints Orthodox Church, 205 Scarborough Street, Hartford, CT 06105, or place it in the offering plate on or before the date of the Church School Social (in 2018: Sep 9th). If using Cash, please indicate on enevelope that it is for "Church School Registration: LAST NAME." Checks should be made payable to "All Saints Orthodox Church," with a memo Line: "Church School Registration." You may also pay online by going to our website and clicking "DONATE" on the blue pane on the right.

I agree.

Required

Send me a copy of my responses.

Submit

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