Crash Club
2023-2024
Crash Club Sign-Up Form
*
indicates required
Name:
Email:
Comment:
Parent/Guardian First and Last Name
*
Phone Number
*
Email Address
*
Student's Full Name
*
Grade
PK
Kinder
1st
2nd
3rd
4th
5th
Second Child's Full Name
Grade
PK
Kinder
First
Second
Third
Fourth
Fifth
Third Child's Full Name
Grade
PK
Kinder
First
Second
Third
Fourth
Fifth
Emergency Contact Name - Other than Parent
*
Emergency Contact Number - Other than Parent
*
Media Consent
I understand that Crash Club may occasionally video and/or photograph children during the after-school program for promotional use, social media posts, and in future Crash Club media sources. I consent and agree that Crash Club may use my participating child's name, image, and/or likeness in Crash Club media.
Medical Consent
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In the event my child(ren) was to sustain an injury or become ill during a Crash Club program and my emergency contact cannot be reached, I give permission to Crash Club, theCRASH Church, Beta Academy, and/or CT Church (together, the "Participating Entities") to secure proper treatment for my child(ren). I understand that I am responsible for all the expenses incurred for such treatment.
Hold Harmless Release
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I hereby waive, release, absolve, indemnify, and agree to hold harmless Crash Club, and the Participating Entities, as well as their employees and volunteers; for, from, and against all liability because of any bodily injury, or property damage, known or unknown, which may occur or result from the participation of the above named child(ren) in any and all Crash Club activities.
Accept Terms & Conditions
*
I am the parent/legal guardian of the participant(s). I have read this Program Acknowledgement, Consents, and Release and agree to the terms therein on behalf of myself and my child(ren), and I consent to my minor child(ren) participating in the Crash Club program.