Register - Cypress Creek Church

Number of Kids Registering:*

Please enter a number from 1 to 4.

Child #1

Age (Child #1)*

Grade (Child #1) (entering into the fall)*

Allergies (Child #1):*

Child #2

Age (Child #2)*

Grade (Child #2) (entering into the fall)*

Allergies (Child #2):*

Child #3

Age (Child #3)*

Grade (Child #3) (entering into the fall)*

Allergies (Child #3):*

Child #4

Age (Child #4)*

Grade (Child #4) (entering into the fall)*

Allergies (Child #4)*

Contact Information

Phone*

Email*

Parent Release

I, the undersigned, hereby release Cypress Creek Church, it's agents, employees, officers and servants, from any and all damages and injuries which may occur while (I/ my child) is participating in any/all Cypress Creek Church activities, on or off the premises. I also give my permission for Cypress Creek Church leadership to seek medical attention by a licensed physician in the event of a medical emergency. I certify that I have the legal authority to execute this release on behalf of (myself/ my child). I also agree, by signing below, that the above information is true and correct to the best of my knowledge.

Participant or Parent/Guardian Signature (if under 18 yrs. old)*

Date*

Payment

T-Shirt Cost

Credit Card*

Card Details

Cardholder Name

Total