Parents' Day Out Registration

ONLY A LEGAL PARENT/GUARDIAN MAY REGISTER A CHILD.

Information in this section is about the child/children who you are registering for Parents' Day Out. You can register up to 5 children using this form. Please e-mail Terri Hall (thall@avonumc.net) after you have registered to add additional children to your registration.

Enter information about who, in addition to the parents/guardians listed on page 1, should be contacted in the event of an emergency or illness during PDO hours. We will contact the parent/guardian first, then the following individuals in the order they are listed. These individuals will also be permitted to pick up the child in the absence of the parent/guardian.

A $125 registration fee is required per child to complete the registration process. PDO fees are structured to ensure that your child receives the best possible care and instruction during his or her time with us. The registration fee holds your child’s spot either in a classroom or on our waiting list and provides for administrative costs associated with receiving your child into the program. Once you've completed this form, you will receive a link via email that will direct you to be able to pay the registration fee online.

We require that the parent or guardian of each PDO participant consent to the child's participation in the PDO program. The electronic signature below will be binding as your actual signature. By signing this form you indicate your agreement with the following statements: 

• I certify that I am the legal parent/guardian of all children named on this form.
• I hereby give my consent for my minor child/children, named above, to attend and participate in the Parents' Day Out program at Avondale United Methodist Church. This permission will persist until I withdraw my child/children.
• I authorize an adult, in whose care the minor has been entrusted, to consent to emergency medical treatment to be rendered to the minor under the general or special supervision and advice of any physician licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital. I understand, however, that every effort will be made to contact me before any such medical treatment is administered. 
• I understand that I am liable and agree to pay all costs and expenses incurred in connection with such medical services rendered to the aforementioned minor pursuant to this authorization. 
• I hereby release Avondale United Methodist Church from any responsibility other than normal supervision and care. In case of an accident, I will not hold Avondale United Methodist Church, or its staff members, management or officers liable unless guilty of gross negligence. 
• I hereby consent to my child/children being interviewed, photographed, or videotaped by representatives of Avondale United Methodist Church for use in advertising, publicity, or educational activities including, but not limited to, church participation and/or videos, print and television broadcasts, news, and church websites. I hereby waive any claims I may have and release the church and its employees from any liability or claims arising out of such activities.