Frolic Registration

Frolic Faith Class for Toddlers, Age 2+

First Name:

Last Name:

Email:

BEST PHONE :

Authorized First Name:

Authorized Last Name:

Authorized BEST PHONE:

Child #1 First Name:

Child #1 Last Name:

Child #1 Age:

Child #1 Allergies/Medical information:

Child #1 Baptism Info:

Child #2 First Name:

Child #2 Last Name:

Child #2 Age:

Child #2 Allergies/Medical information:

Child #2 Baptism Info:

Child #3 First Name:

Child #3 Last Name:

Child #3 Grade:

Child #3 Allergies/Medical information:

Child #3 Baptism Info:

Child #4 First Name:

Child #4 Last Name:

Child #4 Age:

Child #4 Allergies/Medical information:

Child #4 Baptism Info:

I grant permission to St Paul’s Episcopal Church, Riverside CT, its agents, employees and its designated volunteers the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while at St. Paul’s Episcopal Church, Riverside CT, or any off-site church-sponsored event for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium. I hereby release St. Paul’s Episcopal Church, Riverside CT and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.

I agree to the above photo release statement for all children named

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Frolic Faith Class for Toddlers, Age 2+

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