Student Name(Required) First Last Homeroom Teacher/Grade(Required)Click to SelectLaura O'Connor/PSJulia Townsend/PSCarolyn Younkin/PSCheryl Lamon/Pre-KJessica Matthews/Pre-KAleigh Vancaster/Pre-KAnne Fava/KindergartenAmy Wong/KindergartenAlex Wilson/1st GradeToni DeRenzo/2nd GradeLinda Wilson/2nd GradeStephanie Andrisse/3rd GradeAngie Melfi/4th GradePhyllis Everette/5th GradeMalena Smith/6th GradeKrista Nasr/7th GradeMelissa Barrett/8th GradeBeth Linsenmeyer/8th GradePop-Up Club #1Click to SelectButterflies and a Book! (Tues. 5/16)Parent Name First Last Parent Email Parent Contact #Additional Emergency Contact Name Contact #Student Pick-upParentMustang ClubOtherStudent Pick-Up Other 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)Signature Total Credit CardCard Details Cardholder Name Note: In the event that activities are canceled, funds will be applied to the next session of clubs and activities. CommentsThis field is for validation purposes and should be left unchanged.