Home » Community Education » Saints Kids » Saints Kids Registration Saints Kids Registration Please complete one form per child. Fields marked with an * are required HTML Select Events * HTML Total cost: $0.00 Child's First Name * Child's Last Name * Child's Date of Birth * Child's Gender * Male Female Other Unknown Child's Ethnicity * American Indian / Alaska Native Asian Black / African American Hawaiian / Pacific Islander Middle Eastern North African White Other Street Address * City * State * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * School Phone * SSN Emergency Contact Name * Emergency Contact Phone * Additional Information (Please list any allergies) HTML PARTICIPATION AGREEMENT AND PRESS RELEASE: As a participant in this program, I understand that there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages, or loss that my child may sustain as a result of participating in any and all activities associated with Saints Youth. I agree to waive and relinquish all claims I may have as a result of my child participating in this program against Shawnee Community College, its employees, board member, and associates. I authorize Shawnee Community College to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my child’s immediate care, and I agree to be responsible for payment of any and all medical services rendered. I have read and fully understand the Program Details and Waiver and Release All Claims. I certify that all the information that I have provided on this application is complete and accurate to the best of my knowledge and I agree to observe all of the rules and regulations of the institution at which I am enrolled. I agree * HTML PHOTO RELEASE: I understand that Shawnee Community College may photograph my child during Saints Kids camps and that these photos may appear in newspapers, pamphlets, and on the Shawnee Community College Website for promotional and informative purposes. Please choose one. * I give consent for my child to be photographed for this purpose. I do not give my consent for my child to be photographed. Parent/Guardian Signature * Email * HTML Copy Total cost: $0.00 If you are a human seeing this field, please leave it empty.
