CREW REGISTRATION 23-24

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Participant's Name

First

Last

Participant's Age

Participant's Birthdate

Participant's Gender

Male
Female

2023-2024 Grade School Year

T-Shirt Size

Allergies/Medical Concerns etc.

Special Requests or Other Helpful Information

Street Address

City, State, Zip

Parent/Guardian Name

First

Last

Parent/Guardian Phone Number

Parent/Guardian Email

Alternate Emergency Contact

First

Last

Alternate Emergency Phone Number

I give the above participant permission to participate in CREW at Pratt Presbyterian Church for the year 2023-2024. I authorize Pratt Presbyterian Church to use photos, videotapes, and other likenesses of said participant for social media and/or promotional materials regarding Pratt Presbyterian Church programs, facilities, or services.

Rides can be available, upon request, to and from Wednesday night CREW. By selecting "yes", I give permission for a Church volunteer to pick-up and/or take home the above mentioned participant.

Yes
No, I will provide transportation

Once a month CREW sponsors an activity night, some activities require transportation from Church after the 5:30 guardian drop-off. By selecting "yes", I as legal guardian give permission for the above participant to be transported by a Pratt Presbyterian Church volunteer (over the age of 22), to said activities. I understand that the participant and driver are expected to follow all applicable laws regarding riding in a motor vehicle. (copy)

I certify that I am the parent/legal guardian of the aforementioned participant and have the ability to grant/deny permission to participate in CREW at the Pratt Presbyterian Church for the 2023-2024 school year.

Full Name

Date