REGISTRATION FORM

Your Name (Parent/Guardian) *
Your Name (Parent/Guardian)
Address *
Address
Your Phone *
Your Phone
Emergency Contact *
Emergency Contact
In the event that we cannot find you at our Chamber event and help is needed. Who should our volunteers contact about your children?
Emergency Contact Phone #
Emergency Contact Phone #
Please describe briefly so we can keep your child(ren) as safe and healthy as possible while they are in our care. This information will only be shared with the volunteer supervisor and sitters watching your kids. This includes food allergies, drug allergies, other known irritants.
Hold Harmless Agreement
By checking the box below you agree to hold harmless any persons or institutions associated with the Somerset Chamber of Commerce, the Somerset School District, and all other parties involved with ChamberKIDZ of any liability, wrong-doing, accident or injury, or any and all other negative situations. You agree to voluntarily leave your child(ren) in the care of volunteers during the dates and times that ChamberKIDZ child care is offered. If you do not agree to these and/or any and all other release of indemnity clauses then please do not continue with this form.
Name (Child #1) *
Name (Child #1)
Date of Birth (Child #1) *
Date of Birth (Child #1)
Name (Child #2)
Name (Child #2)
Date of Birth (Child #2)
Date of Birth (Child #2)
Name (Child #3)
Name (Child #3)
Date of Birth (Child #3)
Date of Birth (Child #3)
Name (Child #4)
Name (Child #4)
Date of Birth (Child #4)
Date of Birth (Child #4)
Name (Child #5)
Name (Child #5)
Date of Birth (Child #5)
Date of Birth (Child #5)
Name (Child #6)
Name (Child #6)
Date of Birth (Child #6)
Date of Birth (Child #6)