Forms

Mother's Day Out

2016-2017 DATES/FECHAS:
We will resume next semester - August 15th & 29th

9:00 am - 1:00 pm
$10 per child/por niño

For anyone with children from 6 weeks (6 semanas) to Four years old (4 años de edad).

*This summer we will be taking kids that have completed 1st-3rd grade

DEADLINE: Friday before date.
  • First Name
    Last Name
  • /
    /
  • First Name
    Last Name
  •  
  • (Please let us know what special needs your child has so that we can make the accommodations necessary):
  • Emergency Contact/ Contacto de Emergencia
  • First Name
    Last Name
  •  
  • Doctors Information/Información del Doctor
    Please Bring Current Shot Records to put in file.
  •  
  • Electronic Signature
    I hereby give my permission for my child to attend and participate in Calvary Baptist Church Mother's Day Out and any activities planned by Mother's Day Out.

    I do herewith authorize emergency treatment to be given if necessary only after reasonable effort has been made to reach us/me the parents or emergency contact.

    I, the undersigned do hereby release and agree to hold harmless the Mother's Day Out Leadership and Calvary Baptist Church from any and all liabilities or claims for personal injury or illness which may be incurred by my child while attending and participating in Mother's Day Out and its activities.
    --------------
    Le doy permiso a mi hijo (a) de asistir y participar en Mother's Day Out de Cal-vary Baptist Church.

    Doy autorización de que se le de tratamiento de emergencia si es necesario solo después de haber hecho el intento razonable de contactarnos a nosotros o nuestro contacto de emergencia.

    Yo, el firmante, libero y estoy de acuerdo en mantener indemne a el liderazgo de Mother's Day Out y Calvary Baptist Church de cualquier y toda responsabilidad o reclamos por lesiones personales o enfermedad que pueda incurrir mi hijo(a) mientras asista y participe en Mothers Day Out y sus activi-dades.
  • /
    /
  • Snack provided by church, lunch provided by parent.
  • Please make $10 payment at time of drop off.