Caravan Registration Form 2011-2012

Below you will find the registration form for the 2012-2013 Caravan year. There is also a fall registration fee of $10 to help offset the costs of workbooks and supplies. You may send this with your child on Wednesday night.

At the right you will find a downloadable registration form if you would rather print it out and send with your child.

A complete registration packet will soon be available, which will include: Caravan brochure, Policy & Procedures and the current year's calendar.

Caravan Registration Form.xlsx
Size : 14.983 Kb
Type : xlsx

2012-2013 Caravan Registration

Child's Name

Age/Grade (as of August 1, 2012)

Date of Birth (MM/DD/YY)

Address (Street, City, State, Zip)

Phone #

Parent(s) Name(s)

Transportation

Names of siblings/relatives in Caravan or Teens

Shirt Size

EMERGENCY CONTACT: (Name, relationship, phone #)

List ALL known medications, allergies, etc.

The child named above has my permission to participate in the Caravan program at the Hattiesburg First Church of The Nazarene this year. I consent to the policies and procedures established for participation in this program, including the method of transportation indicated above and field trips and travel for badge activities planned and announced throughout the year. I also give permission to the Caravan staff to render the necessary medical attention to my child in the event of an emergency. I understand the risks involved in this activity and agree to forever release, discharge, and covenant to hold harmless the church and all Caravan leaders from any and all claims, demands, expenses, loss of services, and causes of action belonging to the minor child or to the undersigned out of or on account of any injury, sickness, disability, loss, or damages resulting from participating in Caravan activities.

I have read and understand the above statement.

PHOTO RELEASE: I give permission to Hattiesburg First Church of The Nazarene to Photograph and/or video my child during any church-related activities. I give permission to copyright, use and publish the photos/vidoes for any lawful purpose, including newspaper articles, church publications, and church website.

I give permission for my child to be photographed and/ or videotaped
I DO NOT give permission for my child to be photographed and/ or videotaped

MEMBERSHIP REQUIREMENTS: Participation in the Caravan program is a privilege with membership requirements. In order to join a group, each child must pay an annual fee and complete the membership requirements. The membership requirements include regular attendance, learning the basic Caravan principles, completing badge work, and following official Caravan policies and procedures. PLEASE REVIEW ALL GUIDELINES INCLUDED IN YOUR REGISTRATION PACKET AND GO OVER THEM WITH YOUR CHILD.

Parent's Signature