After School Club Signup

* Indicates required field

Parent/Guardian Name *

First

Last

Email *

Phone Number *

Student's Name, Date of birth, Grade *

Medical/Allergy/Other Concerns *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

My family is zoned for North Warren Central School. *

Yes No I'm not sure

Emergency Medical Acknowledgment/Liability Waiver
In the event of an emergency and I cannot be reached, I hereby give permission for the participant to receive any medical/surgical treatment which is determined by Horicon Baptist Church and/or other medical personnel of any healthcare facility, to be necessary for his/her well-being. I assume all risks which may be involved in the participant's involvement in the activities of Horicon Baptist Church. I hereby forever release Horicon Baptist Church, its directors, employees, agents, and members from any liability, claims, or demands of any nature whatsoever which may be incurred while this/these persons are participating in the activities of New Hope Community Church.

Agree

Submit

​After School Club Signup

After School Club Signup