Register

Child's Name

Child's Birthday

Grade Entering in Fall of 2026

Childs Gender

Parent/Guardian Name

Relationship

Cell Phone

Additional Parent/Guardian Name

Relationship

Cell Phone

Address

Does your child take any medication for a medical condition/disability?
If so, please list medication and instructions

Does your child have any allergies? If so, please list them.

Are there any other needs of which we need to be aware?

AUTHORIZATION FOR EMERGENCY CARE TO MINOR(S)

It is commonly understood that the parent (or legal guardian) is responsible for attending to the care of a minor child while a family is engaged in worship, education or fellowship at St. John’s Church. However, in the event of emergency care I, the parent or guardian of the minor(s) do hereby authorize any emergency X-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment by any physician or dentist licensed by the State of Oklahoma and hospital service that may be rendered to said minor whether such diagnoses or treatment is rendered at the office of the physician or dentist, or at a hospital licensed by the State of Oklahoma. This consent shall remain effective until the minor reaches the age of legal consent, unless sooner revoked in writing, delivered to said physician or dentist or said persons entrusted with the custody, care and control of said minor child or children.

Acknowledgment

I consent to the above authorization

Name of authorizing parent/guardian

Name and telephone number to contact if Parent or Legal Guardian cannot be reached

Medical insurance information (Company, Policy or Group Number, etc.)

PHOTO RELEASE FORM

ACKNOWLEDGEMENT AND CONSENT
I give permission for photographs in which I appear to be used for publications and public relations activities by Saint John’s Episcopal Church. This may include use in print and electronic media, social media, including the internet

Acknowledgment

I consent

Note:

The Saint John’s Episcopal Church Photo and Video Policy sets forth guidelines for images commissioned and used by the church. It makes no attempt to regulate the personal use of cameras during our events. However, we ask that everyone be mindful of privacy concerns when taking images—moving or still—and/or posting them to social media websites.