Parent's Day Out Sign Up
Child's Name
*
First Name
Last Name
Child's Name (Optional if signing up second child)
First Name
Last Name
Child's Name (Optional if signing up a third child
First Name
Last Name
Date of Birth (for all children signing up)
*
Any medical information we need to know about?
*
Parent Name
*
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Email
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Liability Release Form As the parent or guardian of the above referenced child, I hereby give permission for our child to participate in Parents Day Out at St Paul United Methodist Church. I recognize that this is a drop off event that involves snacks, playing games and doing crafts and that there are inherent risks involved. On behalf of my child and on our own behalf, I agree to waive all claims against St Paul UMC and it’s owners, staff and instructors for any liability, loss, cost, damage, medical expense, long-term care or emotional distress arising out of any personal injury, including total disability, paralysis and death, which may occur to any of the children while on the premises of or under the instruction, supervision, or control of St Paul UMC. I hereby testify to my child’s sound health of mind and body and authorize St Paul UMC to seek medical treatment at the nearest medical facility in case of emergency.I have read and understand all the above and agree to the above terms, including the Risk and Waiver of Liability. Please Sign Here.
*
Comments and/or Questions?
I understand that in order to be signed up for this event I need to pay in advance. Type Yes
*
Continue
Continue
My Products
*
prev
next
( X )
1 Child
$40.00
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
2 Children
$75.00
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
3 Children
$110.00
$
110.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Should be Empty: