Troops registration

Child's Name*

First NameLast Name

Child's Birthdate *

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

Emergency Contact: Name (s) and Number (s) *

Allergies to ANY foods or Medical Problems: *

Will child need transportation: *

YesNo

PERMISSION TO TRANSPORT
In consideration for The Salvation Army providing transportation for the Participant, I agree on behalf of myself and on behalf of the Participant, as well as our estates and assigns, to relieve The Salvation Army and its officers, directors, employees, volunteers, and agents from any and all liability, including without limitation negligence, in connection with any injury, loss, or damage to person, including death, or any injury, loss, or damage to property in connection with Participant’s transportation, to the maximum extent permitted by law.

Do you give permission for The Salvation Army to transport for pickups or field trips related to special activities associated with the program?*

PHOTO/PUBLICATION RELEASE
I hereby grant to The Salvation Army and any of its’ assigns or agents the unrestricted right to print, copyright, publish, or otherwise use, for any purpose, my name, signature and likeness as often as The Salvation Army requires. This includes using my name, signature, and likeness in any photograph, artwork, or other representation of me in which I appear. The Salvation Army can use my name, signature, and likeness in any advertising, display, or publication at its discretion. In its use of my name, signature, or likeness of me, The Salvation Army may make changes or additions at its discretion. This includes placing my name, signature, or likeness of me, along with the likeness of others. This also includes accompanying a photograph or likeness of me with another name (real or fictitious), or accompanying a photograph or likeness of me with any statements or testimoni- als made by me in any advertising, display, or publication at The Salvation Army’s discretion. I grant the above rights to The Salvation Army, understanding that I will receive no payment or redress in their use for private or public circulation.

Photo release approval *

MEDICAL RELEASE
Being the legal guardian of the child named above I authorize The Salvation Army, acting through any adult officer thereof, into whose care the said minor has been entrusted, to consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to said minor under the general or special supervision and upon the advice of a physician and surgeon licensed under the provisions of the state medical practice act or to consent to an X-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor by a dentist licensed under the provision of the dental practice act. Notification to a parent will not be made for minor injuries or illnesses. In the case of serious injuries (cuts requiring stitches, head injury, broken bones, etc.) I wish the child named above sent to a hospital and skilled medical aid called once, for which I expect to pay the usual charges. I wish The Salvation Army to contact me at once for any injury requiring hospitalization or serious medical attention.

Medical release *

Parent Conditions Agreement (Digital Signature) *

If allowed to attend The Salvation Army Youth programs, I promise to abide by the rules and will cooperate with all leaders. I believe that cooperation between kids and staff is necessary for safe and enjoyable times. I further agree to participate in all activities and to be respectful to the staff and other kids alike.

Child Signature (Please review with child) *