Student Name(Required) First Last Homeroom Teacher/Grade(Required)Click to SelectJulia Townsend/PSRachel Savani/PSHeather McGowan/PSCheryl Lamon/Pre-KLexi Gottermeyer/Pre-KJessica Lundeen/Pre-KAmy Wong/KindergartenAlex Wilson (Taylor Morris)/1st GradeToni DeRenzo/1st GradeLinda Wilson/2nd GradeStephanie Andrisse/3rd GradeBeth Howard/3rd GradeAngie Melfi/4th GradePhyllis Everette/5th GradeMelissa Barrett/6th GradeKrista Nasr/7th GradeBeth Linsenmeyer/8th GradeAllergies or Health Concerns? (If none, please put N/A)(Required)Pop-Up Choice #1(Required)Click to SelectUnicorn Extravaganza (K - 3rd; Tuesday, Nov. 14)Pop-Up Choice #2Click to SelectPop-Up Choice #3Click to SelectChild's T-Shirt Size (for tie-dying pop-up) 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 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. Untitled PhoneThis field is for validation purposes and should be left unchanged.