The Neighborhood Registration

Basic Information

Registrant Name

Registrant Type

Adult (18+) Child/Youth

If a child/youth, list grade

Date of Birth

If a minor, Parent/Guardian Name

Email/Parent Email

Phone/Parent Phone

Address

Health & Safety

Please list any food allergies

Please list any medical conditions or special needs our team should be aware of

Emergency Contact Name (other than parent/guardian listed above)

Emergency Contact Phone

Authorized Pick-up Names (for children's groups only)

Communications & Media

How did you hear about "The Neighborhood?"

Photo Release (read below)

Yes, I give permission No, I do not give permission

I hereby grant New Hanover Presbyterian Church permission to use my likeness or my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

The End

Is there anything else you would like us to know?

Description

Thursday evenings, 5:30-7:30pm, beginning Oct. 22nd

Welcome to The Neighborhood, where everyone belongs. Thanks for registering!

The Neighborhood Registration

Description

Please Fix the Following