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Child's Name (1)*

First Last

Age*

Child's Name (2)

First Last

Age

Child's Name (3)

First Last

Age

Child's Name (4)

First Last

Age

Child's Name (5)

First Last

Age

Parent's Name*

First Last

Phone*

Email*

Enter Email Confirm Email

Emergency Contact Name*

First Last

Emergency Contact Phone*

please give the best phone number to reach someone in case of an emergency

Dates that my child(ren) can't attend

How'd you hear about this program?

personal invitation
magazine
Facebook
church
Hosanna e-blast
other

Parental Consent*

My son or daughter has my consent to attend Acorn Club at Hosanna Industries, Inc.

Medical Consent*

Hosanna Industries, Inc. has my permission to administer or have administered any medical attention necessary in the event of accident or injury.

Photo Consent*

I, the undersigned, permit use of photos and/or video images portraying my child in publications promoting Hosanna Industries, Inc.

Liability Release*

I hereby release Hosanna Industries, Inc. (as well as its successor(s) and assigns) from any and all claims for damages, whether to person or property, arising from any accidents or injuries, direct or indirect, including travel to and from the day’s activities, which are caused or arise from my participating with Hosanna Industries' Acorn Club.

Insurance Carrier*

Hosanna Industries' participants must have medical coverage. In the event of an injury, parents must present their own medical insurance information to the doctor or medical service that will be treating your child.

Special Medical Considerations

Comments

Feel free to tell us anything you'd like us to know about your kid(s), summer birthday? we love celebrating!, favorite things to do, things they don't like to do, anything you want us to focus on?

Registration/payment

Price: $175.00

Please indicate how many children you are registering

Hosanna Industries

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