Registration Form for Rangers & Mpact Girls

• • Your E-mail*
     
  • Parent's Name*
    First Name

    Last Name
  • Phone Number*
     

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  • Parent's Name
    First Name

    Last Name
  • Phone Number
     

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  • Address
    Street Address

    Address Line 2

    City

    Province / State / Region

    Postal Code / Zip

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    Country
  • Where will you be during club hours?*
  • Other persons authorized to pick up your child(ren)
    First Name

    Last Name
  • Other persons authorized to pick up your child(ren)
    First Name

    Last Name
  • Other persons authorized to pick up your child(ren)
    First Name

    Last Name
  • Other persons authorized to pick up your child(ren)
    First Name

    Last Name
  • Call in an emergency
    First Name

    Last Name
  • Phone Number
     

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• Section Break
  • 1st Child's Name*
    First Name

    Last Name
  • Grade*
  • Age*
  • Date of Birth*
  • Allergies
  • T-Shirt Size*
    Youth 4T

    Youth 5T

    Youth XS

    Youth S

    Youth M

    Youth L

    Adult S

    Adult M

    Adult L

    Adult XL
  • 2nd Child's Name
    First Name

    Last Name
  • Grade
  • Age
  • Date of Birth
  • Allergies
  • T-Shirt Size
    Youth 4T

    Youth 5T

    Youth XS

    Youth S

    Youth M

    Youth L

    Adult S

    Adult M

    Adult L

    Adult XL
  • 3rd Child's Name
    First Name

    Last Name
  • Grade
  • Age
  • Date of Birth
  • Allergies
  • T-Shirt Size
    Youth 4T

    Youth 5T

    Youth XS

    Youth S

    Youth M

    Youth L

    Adult S

    Adult M

    Adult L

    Adult XL
  • 4th Child's Name
    First Name

    Last Name
  • Grade
  • Age
  • Date of Birth
  • Allergies
  • T-Shirt Size
    Youth 4T

    Youth 5T

    Youth XS

    Youth S

    Youth M

    Youth L

    Adult S

    Adult M

    Adult L

    Adult XL
  • 5th Child's Name
    First Name

    Last Name
  • Grade
  • Age
  • Date of Birth
  • Allergies
  • T-Shirt Size
    Youth 4T

    Youth 5T

    Youth XS

    Youth S

    Youth M

    Youth L

    Adult S

    Adult M

    Adult L

    Adult XL
  • 6th Child's Name
    First Name

    Last Name
  • Grade
  • Age
  • Date of Birth
  • Allergies
  • T-Shirt Size
    Youth 4T

    Youth 5T

    Youth XS

    Youth S

    Youth M

    Youth L

    Adult S

    Adult M

    Adult L

    Adult XL
• Section Break
• Medical/Liability Release

  By submitting this form, you are agreeing to the following:
  I understand that in the event professional medical intervention is needed for a participant in a church related activity, a reasonable attempt will be made to immediately contact the designated parent or guardian listed on this form. In the event I, or the emergency contact listed cannot be reached, I hereby give permission to the activity leader to secure medical treatment for my child as deemed necessary. Hamilton Assembly of God Church will not be financially responsible for services rendered.
  I hereby release Hamilton Assembly of God Church, it's staff members, volunteers, and all other persons associated with Hamilton Assembly of God Church from any and all liability, damages, claims, demands, actions, and causes of actions of any kind, arising out of or in any way related to any activity that my child participates in or at Hamilton Assembly of God Church.
  • Pictures and Social Media Release*
    Hamilton Assembly of God staff / volunteers take pictures / videos to be used for the purpose of promoting Royal Ranger & Mpact Girls on all social media platforms and church website. Please select ONE or TWO options.
    I give consent for my child / children for the PRIVATE facebook page- Hamilton Assembly Mpact Girls & Royal Rangers

    I give consent for my child / children for the PUBLIC facebook page- Hamilton Assembly of God & Kids Zone

    I do NOT give consent
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  Submit