Student Name(Required) First Last Homeroom Teacher/Grade(Required)Click to SelectO'Connor/Garnett - PSPfefferkorn/Anderson - PSCox/Nagy - PSMcGowan/Osborn - Pre-KLundeen/Fretwell - Pre-KFerus/Korvin - Pre-KMonday Club ChoiceClick to SelectKarate Zoo (JumpBunch) (Mondays)Tippi Toes Dance Class (Mondays)Tuesday Club ChoiceClick to SelectSoccer Shots (Tuesdays)Wednesday Club ChoiceClick to SelectMini Monets w/ Artworks Studio (Wednesdays)Thursday Club ChoiceClick to SelectNature Nuts w/ EcoAdventures (Thursdays)Allergies or Health Concerns? (If none, please put N/A)(Required)Parent Name(Required) First Last Parent Email(Required) Parent Contact #(Required)Parent 2 Name First Last Parent 2 Contact #Parent 2 Email Emergency Contact Name(Required)Emergency Contact #(Required)Student Pick-up(Required)Click to SelectParentMustang ClubOtherStudent Pick-Up OtherPlease Choose Your Choice Of Payment Preference:(Required) Billed via FACTS By registering my child(ren) for the above program, I, (Parent/Guardian Name), agree to participate or allow my child(ren) and family members to participate and hereby release St. Martin’s in-the-Field Episcopal School, its directors, officers, agents, coaches, parents, and employees from liability for any injury that might occur to myself (or to my child(ren) and family members) while participating in the program. I agree to indemnify and hold harmless the above-mentioned organizations and/or individuals, their agents and/or employees, against any and all liability for personal injury, including injuries or damage to my property, the property to my child(ren), and/or other family members, or both, while participating in the program.Consent(Required) Yes I agree(Required)SignatureTotal Note: In the event that activities are canceled, funds will be applied to the next session of clubs and activities. CompanyThis field is for validation purposes and should be left unchanged.