Coopersville Reformed Church - The Nest Sign Up

The Nest Sign Up

Please complete the entire form so we can keep our records up-to-date. The Nest runs from October-May.

First Name

Last Name

Address

Email Address

Phone Number

Child 1 Name

Birthdate

Child 1 Grade

Allergies (please list for each child)

Anything else you'd like to share? (please list for each child if needed)

Child 2 Name

Birthdate

Child 2 Grade

Child 3 Name

Birthdate

Child 3 Grade

Child 4 Name

Birthdate

Child 4 Grade

Do you need transportation for your kids?
Yes
No

In case of emergency, contact: (name and phone number)

Relationship to child(ren):

Please read the following and indicate your preference. This will apply to all your children unless you notify us differently.

Web Permission
Yes
No

We are posting pictures of our church “in action” on our website and on our CRC Facebook page. We are not putting names of the children by any of the pictures. Please check the box authorizing us to post pictures of your child(ren) on the web. If there is any reason the above-named child(ren)’s picture should NOT appear on the web, please notify the church office immediately (616-837-8949).

Medical
Yes
No

I understand that accidents and illnesses can occur. If first aid is required, it may be provided by church staff or volunteers prior to the arrival of emergency personnel. If unable to locate me (the parent/guardian), I give permission to supervisors, first aid responders, and any licensed physicians to take all emergency steps that may appear necessary for the care and welfare of the child(ren) registered above. I hereby waive on behalf of myself, spouse, and the above-named child(ren) any liability of the church and of its agents, or employees/volunteers, arising out of such medical treatment.

I give my permission for the child(ren) listed above to participate in The Nest at Coopersville Reformed Church.

Signature (please type name)

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