240000 250000 Trinity Children & Family Enrollment Form Registration

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Trinity Children & Families Enrollment Form Registration

2024–2025 School Year

Please select

CHILD’S INFORMATION

First name:

Preferred name:

Last name:

Date of birth:

YYYY

Pronouns:

Select allClear choices

She/her

They/them

He/him

Other:

CHILD’S INFORMATION — Pre-K–5th grade

Current School

Please select

Please describe any allergies, health, behavioral, or mobility needs:

Please select

CHILD’S INFORMATION – Infant-Toddler

Check all that apply to your infant or toddler at the present time:

Takes a bottle

Talks

Breastfed exclusively

Separated

Eats solid food

Diapers

Sits up independently

Pull-ups

Crawls

Toilet trained

Stands and walks

Please describe any allergies, health, behavioral, or mobility needs:

Anything you would like childcare personnel to know about your baby?:

What groups are you affiliated with? (check all that apply):

Trinity congregation

Trinity preschool (alum)

Trinity sports / Dance program

Trinity Youth Chorus

A Family member in Trinity programs

My teacher / Guidance counselor

NYC K–12 school

Other

A Friend in Trinity programs

Please specify NYC K–12 school:

Please specify other:

PARENT/GUARDIAN INFORMATION

Parent/guardian 1 first name:

Parent/guardian 1 last name:

Parent/guardian 1 cell (to be used for emergency purposes):

Please select

Parent/guardian 1 email:

* Your email will be used only as your unique identifier and for your confirmation reply unless you opt in to other communications. Please see our full Privacy Policy.

Please select

Parent/guardian 1 address:

Please select

PARENT/GUARDIAN 2 (Optional)

Parent/guardian 2 first name:

Parent/guardian 2 last name:

Parent/guardian 2 cell (to be used for emergency purposes):

Please select

Parent/guardian 2 email:

* Your email will be used only as your unique identifier and for your confirmation reply unless you opt in to other communications. Please see our full Privacy Policy.

Parent/guardian 2 address:

Please select

EMERGENCY CONTACT INFORMATION

In cases of emergencies, parent/guardian 1 is the default contact. Please list additional emergency contacts.

Emergency contact #1 first name:

Emergency contact #1 last name:

Emergency contact #1 phone

Please select

Emergency contact #2 first name:

Emergency contact #2 last name:

Emergency contact #2 phone:

Please select

IF CHILD’S ADDRESS IS DIFFERENT THAN THE PARENT/GUARDIAN ADDRESS, PLEASE RECORD BELOW

Child's address:

Authorized Pick Up/ Emergency Contacts

If anyone else will be picking up your child, it is imperative that you notify the program office or your child’s teachers in writing, on or before the day of occurrence. Trinity Children’s Programs shall not release a child to anyone who is not authorized in writing to pick up and who does not have official picture identification. No child will be released to any person younger than 16 years of age.

The following person(s) is 16 or older and will be allowed to pick up my child from Trinity children’s programs:

Contact #1

Full name:

Relationship:

Check all that apply:

Emergency contact

Authorized pick Up

Cell:

Contact preferences:

Text

Audio Call

Contact #2

Full name:

Relationship:

Check all that apply:

Emergency Contact

Authorized Pick Up

Cell:

Contact preferences:

Text

Audio Call

Contact #3

Full name:

Relationship:

Check all that apply:

Emergency Contact

Authorized Pick Up

Cell:

Contact preferences:

Text

Audio Call

Name of persons PROHIBITED from picking up your child:

Prohibited person full name:

Relationship:

Prohibited person full name:

Relationship:

TRINITY ACTIVITIES PERMISSION, ASSUMPTION OF RISK,WAIVER OF LIABILITY, AND MEDIA RELEASE

In consideration of the benefits received from participating in in-person meetings and activities (which may include travel) (“Trinity Activities”) sponsored by The Rector, Church-Wardens, and Vestrymen of Trinity Church in the city of New-York d/b/a Trinity Church NYC, including its clergy, wardens, vestry, officers, employees, members, lay leaders, volunteers, independent contractors, agents, and all other persons or entities associated with it (“Trinity”), I, on behalf of myself, and on behalf of the minor or minors listed below who is participating in Trinity Activities and for whom I have the capacity as parent or legal guardian (each, a “Minor”), acknowledge and agree as follows:

Assumption of Risks: Participating in Trinity Activities may have inherent risks, hazards, and dangers, and may result in accidents, injuries, property damage, illness, disability, or death. Trinity Activities may occur indoors or outdoors and may require physical exertion, including but not limited to the use of weights and cardiovascular equipment, stretching, and other activities and equipment related to strength and endurance training. Persons leading Trinity Activities may be unpaid volunteers and not professional guides or leaders. I, on behalf of myself, and on behalf of Minor, affirm that we are participating voluntarily in Trinity Activities with knowledge of the risks involved, and I, on behalf of myself, and on behalf of Minor, take responsibility for having appropriate skills, equipment, supplies, and physical conditioning to engage in the specific Trinity Activities. By traveling to and participating in inperson Trinity Activities, I, on behalf of myself, and on behalf of Minor, voluntarily assume the risks and agree to accept sole responsibility for any injury, illness, personal or property damage, loss, claim, liability, or expense of any kind, including but not limited to, those resulting in/from disability or death, from acts of God (including climatic and seismic events), armed conflict, pandemics, and/or exposure to or infection with COVID19 (“Claims”), that I or Minor may experience or incur in connection with my or Minor’s participation in Trinity Activities. I understand that the risk becoming exposed to or infected by COVID19 in connection with my or Minor’s participation in Trinity Activities may result from the actions, omissions, or negligence of others, including but not limited to Trinity employees and other guests.

I, on behalf of myself, and on behalf of Minor, hereby release, covenant not to sue, discharge, indemnify, and hold harmless Trinity (as defined in this waiver) from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating to such Claims.

Permission to travel solo: I attest that Minor is over the age of 12 and may travel to and from these activities on their own.

Yes

Permission to Seek Medical Care: In case of a medical emergency that I or Minor may experience during our participation in Trinity Activities, I, on behalf of myself, and on behalf of Minor, hereby authorizeTrinity to seek care for me and/or Minor if I am unable to seek such care myself, or in the case of Minor, cannot be reached. I consent to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and/or hospital care for myself or Minor deemed necessary by and is to be rendered under the general or special supervision of any licensed medical personnel on the staff of any licensed medical facility. I, on behalf of myself, and on behalf of Minor, hereby release, forever discharge, and hold harmless Trinity from any claim based on such treatment or other medical services. ☐ YES ☐ NO

Yes

EpiPen Notice: If I and/or Minor experience an allergic reaction, I hereby authorize Trinity’s employees and agents to administer or attempt to administer a lawfully prescribed EpiPen, if I am unable to administer it myself. I acknowledge that it may be necessary for the EpiPen medication to be administered to me or Minor by an individual who is not a nurse or medical professional, and I specifically consent to such practice. I, on behalf of myself, and on behalf of Minor, hereby waive any claim for myself, my heirs, executors, assigns, or personal representative that I or Minor might have against Trinity from any liability, from and against any and all claims, damages or causes of action arising out of or in any way connected to self-administration, administration, failure to administer, or attempt to administer EpiPen medication to me or Minor. I further agree to protect, indemnify, defend, and hold harmless Trinity from and against any and all claims, damages or causes of action arising out of or in any way connected to self-administration, administration, failure, to administer or attempt to administer EpiPen medication to me and/or Minor.

Yes

Media Release: In conjunction with my and/or Minor’s participation in Trinity Activities, I hereby grant to Trinity the absolute and irrevocable right and unrestricted permission concerning any photographs or audiovisual content (“Content”) that may be taken by Trinity of me and/or Minor (with or without others) to use, reuse, edit, publish, distribute, broadcast, and display the Content, in whole or in part, in connection with other material, in any and all media now known or hereafter developed, including the Internet, for Trinity’s or its licensees’ religious, educational, charitable, marketing, or other noncommercial purposes. I also consent to the use of my name and/or Minor’s first name in connection with the Content. I hereby release and discharge Trinity from any and all claims and demands that may arise out of or in connection with the use of the Content.

Yes

I certify that I have the capacity to contract in my own name and as parent or legal guardian for Minor listed below and I agree that the release is binding on me, my heirs, representatives, and assigns, as well as the heirs, family, estate, representatives, and assigns of Minor. This release shall be interpreted and controlled according to the laws of the State of New York.

This form is my global permission for myself and Minor to participate in Trinity Activities, and my permission will be effective from the date below through the end of the applicable Trinity Activity unless I withdraw it in writing before that time. I HAVE READ AND UNDERSTAND THIS DOCUMENT AND, I, ON BEHALF OF MYSELF, AND ON BEHALF OF MINOR, VOLUNTARILY AGREE TO ITS TERMS.

Trinity Activity: Trinity Children, Youth, and Family, August 2024 – August 2025

NAME(S) OF ADULT PARTICIPANT or PARENT(S)/GUARDIAN(S):

NAME OF MINOR PARTICIPANT:

ADULT SIGNATURE:

Date

2025