Friend Registration – SonShine Club

Confidential Information & Discrimination Policy

All personal information that is gathered by the SonShine Club, Inc. will be considered confidential and will not be used without obtaining proper consent.

It is the policy of this organization to provide equal opportunities without regard to race, color, national origin, gender, age, or disability. Our simple guideline is to use The Holy Bible, Prayer, and discernment from the Holy Spirit to make decisions.

Thank you for your interest in our program.

Name *

First

Last

Street Address *

City *

ZIP Code *

Shirt Size *

Cell Phone Number *

Email *

Date of Birth *

Month, Day, Year

Allergies/Medications *

Allergies (Including Food), Medications

Emergency Contact Name (Must be available during Saturday SonShine Club events) *

Emergency Contact Street Address (City, ST, & Zip) *

Emergency Contact Phone Number *

Emergency Contact Email Address *

Relationship to Emergency Contact *

Type of supervision required *

Does our Friend need a trained staff present, can they be left alone, etc.

Preferred form of communication *

Verbal, sign, etc.

Nutrition Issues (please list any other safety and health issues that need to be known) *

SonShine Club does not provide special diets. This must be provided by caregivers.

Sonshine Club will be taking pictures...lots of pictures. We hope you will allow us to use picture on our website or on any other media to further the ministry. By signing below you will consent to and authorize the use and reproduction by the SonShine Club, Inc. of any and all photographs, videos, and any other audio/visual materials taken of you for promotional materials, educational activities, exhibitions, or for any other use for the benefit of the program. *

I have read and agree to the above statement

Photo, Video, and Likeness Release

While participating in activities at the SonShine Club, I understand that the SonShine Club's staff has safety as the utmost priority and will take the proper precautions to make sure no one gets hurt. However, I do realize and understand that there is a risk of injury in participating in activities at the SonShine Club. Understanding the risk, I hereby do release any and all liability of the SonShine Club for any loss, damages, injury, or expense that I may incur as a result of my participation. *

I have read and agree to the above statement

Liability Release

I understand that by signing this Consent Agreement, I give authorization to the SonShine Club, Inc. to secure medical treatment and transportation in the occurrence of a medical incident that could be life threatening or needs immediate treatment. I understand and authorize the SonShine Club, Inc. to release pertinent medical information to authorized Individuals or agencies. *

I have read and agree to the above statement

Medical Treatment Consent and Release

Initial as acknowledgement of the above Release statements *

Date as acknowledgement of the above Release statements *

Month, Day, Year

Parent/Legal Guardian Name *

Parent/Legal Guardian Initial as acknowledgement of the above Release statements *

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