“Share the Good News
like St. Patrick”

PMK’s March 2023 Event
Registration Form

March 4th, 2023 — 9 AM - 11 AM

And we know that in all things God works for the good of those who love him, who have been called according to his purpose.
- Romans 8:28

Child's Full Name

First Name

Last Name

Child's Date of Birth

YYYY

Child's Age

Child's Gender

Male

Female

Child's Current Grade

Allergies?

Medical Information

Any Medications?

Medical Information

Medical Conditions?

Medical Information

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Email

Parent/Guardian Phone

(###)

###

####

Name of Home Church

Pick Up Person Name

First Name

Last Name

Pick Up Person's Phone

(###)

###

####

Release Forms

By signing this form you’ve agreed to the following: Medical Release I give my permission for the church staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the church staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me. Permission to Attend I give permission for my child (named above) to attend the event at the church listed above this form. I understand that the information I give for this registration will only be used by the host church, and that all registration information will be removed from the hosting site by the end of this calendar year. Photo Release I hereby grant the above named church permission to copyright and use photographs/videos taken at said event of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction there-with, or the use to which it may be applied.

Signature

Type Parent/Guardian full name

First Name

Last Name

PINSON MEMORIAL CHURCHHome
Church Staff

PINSON RESOURCES

PRAYER REQUEST

CONTACT US

Address
109 E. Pope Street, Sylvester, GA 31791

Office Phone
(229) 776 - 3358

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Pinson Memorial Church

“Share the Good Newslike St. Patrick”

PMK’s March 2023 Event Registration Form

“Share the Good News
like St. Patrick”

PMK’s March 2023 Event
Registration Form