FIELD Days Child Registration 2025

Parent/Guardian Name

This address will receive a confirmation email

Primary Phone

Alternate Phone

Emergency Contact Name (during FIELD Days events)

Emergency Contact Phone (during FIELD Days events)

Below are name(s) of adults other than myself whom I approve to pick up my child(ren) at the end of the event. We will release your child ONLY to you and the adults listed below:

Child(ren) Registration

You may register up to four children (age 4 - 5th grade) with one form.

Child 1 Name

Child 1 Birth Date (mm/dd/yyyy)

Child 1 Grade (2024/2025 school year)

Child 2 Name

Child 2 Birth Date

Child 2 Grade (2024/2025 school year)

Child 3 Name

Child 3 Birth Date

Child 3 Grade (2024/2025 school year)

Child 4 Name

Child 4 Birth Date

Child 4 Grade (2024/2025 school year)

Medical/Health Information

Please list any health issues that may affect the activities, food consumption, well-being, or medical treatment of your child(ren), e.g. conditions like asthma, a physical handicap, allergies, heart condition, etc. Please also indicate any medications your child(ren) may be taking, including EpiPens, etc. if child will have them at FIELD Days. If registering multiple children, please designate to which child the provided information applies.

Photos and Liability

Portage Community Chapel and its representatives may take and use photos, videos, or other imaging formats of children and adults participating in PCC-affiliated ministries and activities. Participation in these activities constitutes agreement for use of such images for website, facebook, advertising, and other related purposes.

Every activity sponsored by Portage Community Chapel is carefully planned and adequately supervised. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, I agree to assume and accept all risks and hazards inherent in church-related activities, both at the church and other locations selected by the church. I also agree not to hold this church or its employees or volunteers liable for damages, losses or injuries up to and including death to the person or property of the participating member(s) listed above. Every attempt will be made to contact a child's parent or emergency contact I have listed on this form. However, if I/they cannot be reached, I hereby give my permission for church leadership and/or medical personel to secure proper medical treatment for myself or my child, as deemed necessary. I understand that my electronic signature below is an acknoledgment of the aforementioned agreement.

Full Name

Date

FIELD Days Child Registration 2025

Description

Please Fix the Following