LOGOS FORM

SRPING 2008 LOGOS Youth Club Registration Form

January 16 – April 30

Turn in to Jeannie McCabe

(late registrations will be accepted)

Child’s Name: ______________________________________________ Grade: ________________________

Street address:______________________________________________________________________________

City/State:__________________________________________________ Zip: _________________________

Home Phone:__________________________________ Date of Birth: (mm/dd/yy) ______/_____/_____

Father's Name:______________________________ Mother's Name: _________________________________

Work Phone:________________________________ Work Phone: ___________________________________

Cell Phone:_________________________________ Cell Phone: ____________________________________

E-mail address: _____________________________________________________________________________

Parents' Church: ____________________________________________________________________________

EMERGENCY Contact Name & Phone:_________________________________________________________

In case of medical emergency, the LOGOS Youth Club personnel are authorized to take my child to the hospital for emergency care.

Signature of Parent/Guardian:__________________________________ Date:________________

I am / am not (circle one) willing for any photos of my child during LOGOS to be used in media and publications (e.g. newsletter, web site).

Signature of Parent/Guardian___________________________________ Date:________________

Do you need child care for younger siblings while you are volunteering on Wednesday nights? _____________

List names & ages of these children:____________________________________________________________

Are there any behavioral, dietary or medical concerns we should know about that may affect the child’s

participation in LOGOS? Please list all FOOD ALLERGIES.: _______________________________________

_________________________________________________________________________________________

PARENT COMMITMENT:

If you have not yet volunteered to help with the LOGOS Youth Club, please circle where you would like to help: (you will be contacted about dates and times)

Table Parent

Kitchen Crew

Bible Study

Worship Skills/Singing

Recreation

Table Decoration Set Up

Completed Registration form must be received PRIOR to your child's involvement in LOGOS Youth Club.