Phone number *
Phone type Mobile Home Work Other
Child's Gender *
Select… Male Female
Does your child have any siblings? *
Please list their first name/s and age/s.
What is your primary language? *
Please list their first name/s and age/s.
What is your main language spoken at home? *
Please list their first name/s and age/s.
Select all the days you are requesting. *
1 day-$100 a month 2 days-$200 a month 3 days-$300 a month 4 days-$400 a month
Pick-Up Person #1 *
Name, Phone Number, and Relationship to the Child
Pick-Up Person #2 *
Name, Phone Number, Relationship to the Child
Pick-Up Person #3
Name, Phone Number, Relationship to the Child
Pick-Up Person #4
Name, Phone Number, Relationship to the Child
Pick-Up Person #5
Name, Phone Number, Relationship to the Child
Pick-Up Person #6
Name, Phone Number, Relationship to the Child
Emergency Contact #1 *
List first and last name and phone number of someone besides yourself that we can contact.
Emergency Contact #2 *
List first and last name and phone number of someone besides yourself that we can contact.
Consent for Emergency Medical Treatment *
In case of emergency, and you cannot be located, we will contact one of the emergency contact names listed on your registration form. If they cannot be reached, we will contact your family doctor to secure medical attention. We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of a physician or dentist licensed under the provisions for the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. The undersigned does also hereby give permission for our(my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Sherwood Oaks Christian Church. I hereby give my permission for you to seek medical attention when needed and am considered the undersigned as referenced above.
Select… Yes No
Who is your child's doctor? *
Include their name and phone number.
Does your child have health insurance? *
Select… Yes No
Does your child have any allergies? *
Does your child have any special health, developmental, social, or medical concerns? *
What services has your child received in the past or is currently receiving?
Immunization Records
If available, you may upload your child's immunization records here. You may also email them to kpitner@socc.org or submit them in person. Immunization records must be received in order for this application to be marked as complete.
Choose 1 file. Maximum file size 10 MB.
Video and Photo Release Authorization *
I consent to the use of my child’s name, voice, image, likeness, and any and all attributes of his/her personality, in, on or in connection with any film, audio tape, video tape, audio-visual work, photograph, illustration, animation, or broadcast, in any media or embodiment, now known or unknown, including, without limitation, all formats of computer readable media, produced by or for the benefit of Sherwood Oaks Christian Church (SOCC). I further consent to the use of my child’s name, voice, image, likeness, and any and all attributes of his/her personality in any advertising or promotional material created or used in connection with Sherwood Kids promotional videos, and each such item of advertising or promotional material will be considered a "Work" for purposes of this agreement. I irrevocably assign to SOCC (a) any and all claims of copyright I may have in and to Sherwood Kids and Sherwood Oaks Preschool promotional videos, and (b) the exclusive and perpetual right throughout the world to use, print, produce, publish, copy, display, perform, exhibit, transmit, broadcast, disseminate, market, advertise, sell, lease, license, transfer, modify, and create derivative works from Sherwood Kids promotional videos in any media or format, now known or unknown, for any purpose whatsoever. I waive any right to inspect or approve the content of Sherwood Kids promotional videos. I agree that SOCC will have no obligation to utilize the authorizations and rights I grant to SOCC hereunder. I hereby release, discharge, and agree to hold harmless SOCC, its legal representatives and assigns, all persons acting under its authority, and those for whom it is acting, from all claims, causes of action and liability of any kind, now known or unknown, in law or in equity, based upon or arising out of Sherwood Kids promotional videos or this agreement including, without limitation, claims of libel, slander, invasion of privacy, right of publicity, defamation, trademark infringement, and copyright infringement. I represent and warrant that I am over the age of eighteen (18) years, I am the parent and/or legal guardian of the child being registered, and that the authorizations and rights granted hereunder do not conflict with or violate the rights of any third party. This agreement will be binding upon my heirs, successors, representatives, and assigns. Please review the attached document at the beginning of this form and then confirm your authorization.
Select… Yes No
By typing your first and last name below, you confirm release of liability. *
In consideration for participation in activities sponsored by Sherwood Oaks Christian Church, the undersigned, for myself and my child, hereby release and forever discharge Sherwood Oaks Christian Church, from any and all actions, causes of action, claims and demands, known or unknown, which I or my child participating in activities sponsored by Sherwood Oaks Christian Church. I acknowledge that there is no worker’s compensation or accident insurance furnished by Sherwood Oaks Christian Church. This release of liability is binding on the undersigned, the child of the undersigned participating in activities sponsored by Sherwood Oaks Christian Church, all persons claiming through the undersigned or said child, and the heirs, personal representatives and assigns of the undersigned and said child.
Submit