Location: The Salvation Army Corps Community Center
710 Pennsylvania Avenue
Sheboygan, WI 53081
Registration
Please select the nights your child is able to attend.
*
April 26
May 24
How many children are you registering ?
*
1
2
3
Child's Information
Name
*
Age
*
(Choose One)
8
9
10
11
12
13
14
15
Grade:
*
School:
*
Does this child have any allergies or physical limitations that the staff should be aware of?
#2 Child's Information
Name
*
Age
*
(Choose One)
8
9
10
11
12
13
14
15
Grade:
*
School:
*
Does this child have any allergies or physical limitations that the staff should be aware of?
#3 Child's Information
Name
*
Age
*
(Choose One)
8
9
10
11
12
13
14
15
Grade
*
School
*
Does this child have any allergies or physical limitations that the staff should be aware of?
*
Parent/Guardian Information
Name:
*
Email
*
Cell Phone Number
*
Work Phone Number
Address
*
State
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AA
AE
AP
If you cannot be reached, who should be notified IN CASE OF EMERGENCY?
Name
*
Phone Number
*
Alternative Phone Number
Additional Individuals Approved to Pick Up
Name
Phone Number
Relationship to Child
Name
Phone Number
Relationship to Child
Terms
*
By signing below, I acknowledge that The Salvation Army, its officers, staff and/or volunteers will not be held responsible for any injury, loss or damage of personal property for the above named individual(s).
If my child will be absent from the program or will be picked up early, I will contact The Salvation Army at least 24 hours before the event/program. I agree to pick up my child at the specified time until other arrangements have been made. I understand that The Salvation Army will not release my child to any individual not listed as a guardian/parent or approved contact.
I give permission to copyright and/or publish images of my child in photographs and/or any media format for the expressed use of The Salvation Army.
I, the undersigned, agree to the terms above.
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