Registration for St. Bonifacius, MN NWD Invitational Quiz Meet

January 11 & 12, 2008

Name:_________________________ Birth date: ________Grade: ____

Address: ________________________________ Postal Code: ________

Telephone: _______________ Parent(s): ________________________

Health Insurance ___________________________________________

Emergency Contact Name & Number: ____________________________

Medical Information/Allergies: ________________________________

_______________________________________________________

Responsibility Waiver and Consent for Treatment

I, ______________________ (parent/legal guardian) give permission for my child, _______________________ (child’s name) to attend and participate in the Bible Quiz Meet held at Crown College in St. Bonifacius, MN, January 11 & 12, 2008. I will not hold _____________ Church or Crown College responsible for any injury incurred traveling to or from the event or at the event itself. In case of emergency, I also give permission for ____________ (coach) to sign for any Emergency Medical Treatment deemed necessary by a Licensed Physician on my behalf after attempting to reach me and being unsuccessful.

Signature:______________________________ Dated: ____________

Registration for St. Bonifacius, MN NWD Invitational Quiz Meet

January 11 & 12, 2008

Name:_________________________ Birth date: ________Grade: ____

Address: ________________________________ Postal Code: ________

Telephone: _______________ Parent(s): ________________________

Health Insurance ___________________________________________

Emergency Contact Name & Number: ____________________________

Medical Information/Allergies: ________________________________

_______________________________________________________

Responsibility Waiver and Consent for Treatment

I, ______________________ (parent/legal guardian) give permission for my child, _______________________ (child’s name) to attend and participate in the Bible Quiz Meet held at Crown College in St. Bonifacius, MN, January 11 & 12, 2008. I will not hold _____________ Church or Crown College responsible for any injury incurred traveling to or from the event or at the event itself. In case of emergency, I also give permission for ____________ (coach) to sign for any Emergency Medical Treatment deemed necessary by a Licensed Physician on my behalf after attempting to reach me and being unsuccessful.

Signature:______________________________ Dated: ____________