Saints Kids Registration

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Total cost: $0.00

Child's First Name *

Child's Last Name *

Child's Date of Birth *

Child's Gender *

Child's Ethnicity *

American Indian / Alaska Native
Asian
Black / African American
Hawaiian / Pacific Islander
Middle Eastern
North African
White
Other

Street Address *

City *

State *

Zip *

School

Phone *

SSN

Emergency Contact Name *

Emergency Contact Phone *

Additional Information (Please list any allergies)

T-Shirt Size *

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PARTICIPATION AGREEMENT AND PRESS RELEASE:

As a participant in this program, I understand that there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages, or loss that my child may sustain as a result of participating in any and all activities associated with Saints Youth. I agree to waive and relinquish all claims I may have as a result of my child participating in this program against Shawnee Community College, its employees, board member, and associates.

I authorize Shawnee Community College to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my child’s immediate care, and I agree to be responsible for payment of any and all medical services rendered. I have read and fully understand the Program Details and Waiver and Release All Claims. I certify that all the information that I have provided on this application is complete and accurate to the best of my knowledge and I agree to observe all of the rules and regulations of the institution at which I am enrolled.

I agree *

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PHOTO RELEASE:

I understand that Shawnee Community College may photograph my child during Saints Kids camps and that these photos may appear in newspapers, pamphlets, and on the Shawnee Community College Website for promotional and informative purposes.

Please choose one. *

I give consent for my child to be photographed for this purpose.
I do not give my consent for my child to be photographed.

Parent/Guardian Signature *

Email *

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Total cost: $0.00

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