Event Registration Form | Marydell Faith And Life Center

Child's Name:(Required)

Birth Date(Required)

Age:(Required)

School:

Grade:

Parent/Guardian:

Address:

Home phone:

Work:

Cell:

Email:(Required)

Swimmer Level

Session

Who will pick up your child (name and phone number)?

Please tell us if there are any medical conditions, we should be aware of:

Backup emergency contacts:

Signature of Parent/Guardian(Required)

Date(Required)

General Permission

I hereby release the Executive Directors and all employees of Marydell Faith & Life Center from all claims of liability for any damages or injuries that may be sustained while my child is in the Marydell Faith & Life Center Program.

Signature of Parent/Guardian:(Required)

Date:(Required)

Photo/Video Release

During our programs we may take photos/videos or be photographed by the press or television. I hereby give permission for my child(ren)’s image to be used in connection with publicity, educational materials, or publications related to Marydell Faith & Life Center. I give permission for my child(ren)’s image to be used as stated above.

Signature of Parent/Guardian:(Required)

Date(Required)

Refund Policy

Withdrawal from the program prior to start of classes will be refunded in full. From that point, withdrawal after two classes, will be refunded minus 25% of total program fee for administrative costs. No refund, for any reason, will be issued after three classes. I understand and agree to abide by these terms.

Signature of Parent/Guardian:(Required)

Date(Required)

Captcha

Event Registration

General Permission

Photo/Video Release

Refund Policy

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Address

Office hours

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