Parent Information:

Parent First Name:		Parent Last Name:
Address 1:
Address2:
City / State / Zip
Email:
Emergency Phone #:	() -Second partThird part

Children Information:

First Name	Last Name	Birthdate	Grade	Medical Info
		Date and timeNow	K3 K4 K5 1st 2nd 3rd 4th 5th 6th
		Date and timeNow	K3 K4 K5 1st 2nd 3rd 4th 5th 6th
		Date and timeNow	K3 K4 K5 1st 2nd 3rd 4th 5th 6th
		Date and timeNow	K3 K4 K5 1st 2nd 3rd 4th 5th 6th

Supplies:

Note: Manually calculate totals

Item	Qty.	Price	Total
Standards		$7.00
Books (K3, K4, K5)		$13.00
Books (1st - 6th grades)		$16.00
Registration		$5.00
	Grand Total

Also, the undersigned, as parent or legal guardian, of the above name child(ren) hereby releases for himself, the child and any other parent or legal guardian of said child, Suber Road Baptist Church or its agents or employees, from any and all liability for any personal injury or property damage arising out of or in any way connected with the activities referred to herein. In addition, the undersigned agrees to hold and save harmless, Suber Road Baptist Church, its agents, or employees from any and all liability. The undersigned does hereby acknowledge that Suber Road Baptist Church does not provide any health insurance covering said child during the activity referred to herein, and further acknowledges that it is the responsibility of the undersigned to obtain his own health insurance covering said child. Parents agree to accept the sole responsibility for the cost of medical care..