Register - Cypress Creek Church

Number of Kids Registering*

Please enter a number from 1 to 4.

Name (Child #1)*

First Last

Age (Child #1)*

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

Allergies? (Child #1)*

Yes

Allergies (Child #1):*

T-Shirt: (Child #1) (youth sizes)*

Name (Child #2)*

First Last

Age (Child #2)*

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

Allergies? (Child #2)*

Yes

Allergies (Child #2):*

T-Shirt: (Child #2) (youth sizes)*

Name (Child #3)*

First Last

Age (Child #3)*

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

Allergies? (Child #3)*

Yes

Allergies (Child #3):*

T-Shirt: (Child #3) (youth sizes)*

Name (Child #4)*

First Last

Age (Child #4)*

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

Allergies? (Child #4)*

Yes

Allergies (Child #4)*

T-Shirt: (Child #4) (youth sizes)*

Parent's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Email Signup

Subscribe me to the monthly Cypress Creek Kids Newsletter

Subscribe me to the Cypress Weekly

Do we have permission to take photos of your child(ren)? **

Yes

Emergency Contact*

Name:

Phone Number:

Insurance*

Insurance Company

Policy #

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*