2007

Registration Application

   
Date:
 
 
Child's Information: Parent/Guardian Information:
Name
Age
Grade (as of Sept. 2007)
School
Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
Work Phone
Emergency Contact
Emergency Contact Phone
Family Accident Insurance
   
Please check session(s):  
 
Release Agreement:

I hereby release Collin County Community College, their agents, employees, and instructors on behalf of myself and my child, from any and all liability for any accident or injury that may be sustained while participating in the above-mentioned activity.  I hereby release liability against any employee required to administer first aid or to obtain medical care from any licensed physician, hospital, or medical clinic for the participant named herein when time is of the essence and/or when the parent/guardian cannot be reached.

 Yes, I agree to this release statement
No, I wish to discuss this statement with someone before agreeing


Copyright © 2005 Collin County Community College District. All Rights Reserved.
Last revised by
Raquel Meyers, February, 2008