Event Registration Event Registration Form Child's Name:(Required) Birth Date(Required) MM slash DD slash YYYY 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) MM slash DD slash YYYY 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) MM slash DD slash YYYY 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.label(Required) Yes No Signature of Parent/Guardian:(Required) Date(Required) MM slash DD slash YYYY 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) MM slash DD slash YYYY Captcha 38123