Palma Ceia Presbyterian Church

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STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Winter/Spring VolleyKids

January 14-April 21, 2020

Grades Pre-K 4 - 2nd will meet for 12 weeks of skills training with coaches John and Grace McClung. VolleyKids will not meet on 3/17, 3/24 or 4/14 to allow for Spring Break & Easter. The cost is $100.00. Sessions will be held in the Palma Ceia Presbyterian Church Gym on Tuesdays.

If you have any questions, please contact John McClung: jmcclung@tampabay.rr.com

Qty

Description

Amount

Total

Child Registration(s)

$100.00

---

per child

Registration is not complete until your payment is successfully processed.

Total: $0.00

Child Information

Please enter your children on one registration form. Click the green button "Show More Child(ren) Information" to add additional children.

Child's Name #1: *

(first, last and preferred name)

Age: *

Date of Birth: *

Grade: *

School:

Gender: *

Known allergies/medical conditions:

Parent/Guardian Information

Parent/Guardian #1: *

Email: *

Parent/Guardian #2:

Email:

Parent Address: *

Address 2:

City: *

State: *

Zip Code: *

Phone Number: *

Questions/Comments:

Additional Information

Emergency Contact: *

Emergency Phone: *

MEDICAL CONSENT & GENERAL RELEASE

I /We do hereby release the staff and officers from liability of accident, illness or injury during his/her participation in School activities at Palma Ceia Presbyterian Church. I/We authorize the persons presenting this form to call a physician and to consent to any transportation, x-ray examination, anesthetic, medical or surgical diagnoses or treatment and hospital care which is deemed advisable for my/our child in case of emergency. It is understood that a conscientious effort must be made to notify me/us before such action is taken.

I have read this release statement, and I understand and voluntarily agree to its provisions.

Permission to Photograph/Video

I give my permission for Palma Ceia Presbyterian Church to take photo/media images of my child and use the images in church created print or digital media.

Permission to Photograph/Video: *

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *