Fillable Ncaa Child Care Registration Form - Nashville Christian Advancement printable pdf download

Ncaa Child Care Registration Form - Nashville Christian Advancement

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NCAA CHILD CARE REGISTRATION FORM

Before and Aftercare Program – Pre-K to 6th

Application Fee (Non-refundable $10.00)

Mother’s Name (First) _________________________________ (Last) ____________________________

Mother Email: _______________________________________ Cell Phone ________________________

Father’s Name (First) _______________________________ (Last) ______________________________

Father Email: _____________________________________ Cell Phone __________________________

Parent Address ______________________________ City ________________________ Zip __________

Child’s Name: ______________________________________________________ Age: ______________

School Name: _________________________________________ Pick-Up Time: ___________________

Child’s Name: ____________________________________________________ Age: _______________

School Name: _________________________________________ Pick-Up Time: ___________________

Please list each child that has any medical conditions & what the condition is:

_____________________________________________________________________________________

List name of person(s) other than the parents who can pick up child from center in case of emergency

Name: _______________________________________________ Relationship: ____________________

Cell#: ________________________

Name: _______________________________________________ Relationship: _____________________

Cell#: ________________________

In the event of an emergency, every effort will be made to contact you immediately. If the parents cannot

be reached and medical care is necessary, we will call an ambulance to transport the child to Tri-Star

Skyline Hospital. We will not be responsible for any medical charges incurred.

I am aware that I am giving my consent to release my child to any of the above-mentioned contact persons

in case of emergency, if I cannot be reached. I hereby state that all information above is correct and

complete. I hereby release Nashville Christian Advancement Academy Before and After Care Camp from

any liability resulting from normal child play, and any further liability.

Parent Signature ____________________________________________ Date ___________________

Ncaa Child Care Registration Form - Nashville Christian Advancement

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