Church of the Nativity

Kids’ and Students’ Registration Form. Using the form below you may register online for our Kids’ and Students’ Program. The cost is $170.00 for one child, $270.00 for two and $370.00 for three or more. Payment can be made with either a credit card or Paypal account. On completing this form, you will be taken to the Paypal web site for the payment process. Alternatively, if you would rather not pay online and would prefer to pay by check or cash, you can simply visit us at the Church's Information Desk.
Fathers First and Last Name:
Mothers First and Last Name:
Email:
Phone:
Fax:
Address 1:
Address 2:
City:
State:
Zip:
How many children will you be signing up today?
Child's Name: Child's Date of Birth: / / Male/Female: Male Female Which Grade will he or she be entering: *If this child is entering grades 1-4 please select a class time: 9:00am 10:30am
Child's Name: Child's Date of Birth: / / Male/Female: Male Female Which Grade will he or she be entering: *If this child is entering grades 1-4 please select a class time: 9:00am 10:30am
Child's Name: Child's Date of Birth: / / Male/Female: Male Female Which Grade will he or she be entering: *If this child is entering grades 1-4 please select a class time: 9:00am 10:30am
Child's Name: Child's Date of Birth: / / Male/Female: Male Female Which Grade will he or she be entering: *If this child is entering grades 1-4 please select a class time: 9:00am 10:30am
Child's Name: Child's Date of Birth: / / Male/Female: Male Female Which Grade will he or she be entering: *If this child is entering grades 1-4 please select a class time: 9:00am 10:30am
I am covered by hospitalization and medical insurance. My policy number is: My policy is issued by: . I do not have medical coverage and assume responsibility for the cost of hospitalization and medical care for my son/daughter. ADD any other medical information concerning medication, allergies, illness, etc. ADD any dietary restrictions: Parents/guardians of participants are advised that photographs or videotape of participants may be used in publications, websites or other materials produced from time to time by the Church of the Nativity. (Participants would not be identified, however, without specific written consent.) Parents/guardians who do not wish their child(ren) to be photographed or filmed should so notify the Church in writing.
Additional comments (such as requests for a teacher): Waiver and Release Form I, as parent or guardian of my son(s)/daughter(s) (hereinafter "child"), BY CLICKING THE SEND BUTTON BELOW, do hereby agree to allow my child to participate in the Religious Education program at the Church of the Nativity. I agree to RELEASE AND HOLD HARMLESS AND INDEMNIFY Church of the Nativity, the Archdiocese of Baltimore, the Roman Catholic Bishop of Baltimore and his successors, a Corporate Sole, and all their agents, servants, and employees from any liability, claims, demands, and causes of action arising out of or relating to any loss, damage, or injury sustained in connection with or arising out of my child’s participation in the Religious Education program. Further, I hereby grant permission to any staff person to obtain medical care from a licensed physician, hospital, or medical clinic for my child in the event that I cannot be reached. *Your information will be transmitted securely.

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