Student Name(Required) First Last Homeroom Teacher/Grade(Required)Click to SelectSavani/PSO'Connor/PSLamon/Pre-KGottermeyer/Pre-KLundeen/Pre-KMcGowan/Pre-KAllergies or Health Concerns? (If none, please put N/A)(Required) Monday Club ChoiceClick to SelectIntro to Ballet (Mondays)Tuesday Club ChoiceClick to SelectWAITLIST ONLY: Nature Nuts w/ Eco Adventures) (Tuesdays)Soccer Shots (Tuesdays)Wednesday Club ChoiceClick to SelectMini Monets (Wednesdays)Thursday Club ChoiceClick to SelectSoccer Shots (Thursdays)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 Other Please 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)Signature Total Note: In the event that activities are canceled, funds will be applied to the next session of clubs and activities. NameThis field is for validation purposes and should be left unchanged.