CHILD'S FULL NAME
School Grade completed
Email address
Parents Names
Full Address:
Physical and Mailing
Home Telephone
 Cell Phone
Home   Church

EMERGENCY INFORMATION in case a parent cannot be reached:
Name, Phones, relationship to child:
Person responsible for pick up at the end of each day:
Name, Phone numbers
Non-Refundable Fee $50.00   

I understand my child will be participating in many events.  I do not
hold Our Savior Lutheran Church or any of its workers or
volunteers responsible for any injuries received during SMAK.

I also understand my child will be transported to other events
during SMAK and do not hold the church, its workers or volunteers
responsible for any injuries received.

I understand that I will receive a copy of the schedule of events
and understand I will need to pick up my child at the event site
when it is away from the church.
I agree that pictures taken throughout SMAK for publicity purposes
with my child in them may be used.
List allergies, etc., comments or questions
and shirt size of participant:
Parent's or Guardian's Signature Acknowledgement:
SMAK Registration Form    
Summer Music & Activities for Kids   
August 3-14; 1-5 pm Mon-Fri
Our Savior Lutheran Church
956-631-6121