CHICAGO FIRST CHURCH OF THE NAZARENE - NAZARENE RECREATION

LITTLE ALL-STARS / CHEERLEADING
PARTICIPANT REGISTRATION FORM

This form is to be completed for a single participant and a single program. Please complete additional forms for other participants or programs.

Children MUST meet age requirement by start of class.
Classes are one hour in length.
Children must be potty trained, no diapers or pull-ups allowed.
Parents are requested to wait outside the teaching area during class.

Special Note for Cheerleading: - A $65 uniform fee is required - Contact the Recreation Office for more information: (708) 349-0460 x32.

* indicates a required field

Select one program per person*

Grade*

School - example: Clark Elementary Orland Park 

Child's Name / First & Last (no apostrophes or commas please) 

T-Shirt Size:

Gender

Birthdate (format: mm/dd/yyyy) 

Address 

City 

State (XX) i.e. IL

Zip 

I am requesting a multiple child $5 discount

ONLY ONE $5 DISCOUNT IS ALLOWED PER FAMILY EACH SEASON. 

Cheer Uniform 

Will you be ordering a cheer uniform today?

Shell Size:

Skirt Size:

Family Participation Information 

Does anyone in your immediate family attend Nazarene Preschool?

Are you interested in learning more about Nazarene Preschool?

Has anyone in your immediate family attended a worship service at First Church of the Nazarene?

Are you interested in learning more about First Church of the Nazarene worship services?

Has anyone in your immediate family previously participated in Nazarene Arts?

Are you interested in learning more about Nazarene Arts?

Has anyone in your immediate family participated in Nazarene Recreation?

Are you interested in learning more about Nazarene Recreation?

Permission Form - Medical Release 

I hereby grant permission for the above named child to participate in the 1st Church of the Nazarene Recreation and Fine Arts Programs. I agree to abide by all Nazarene Recreation and Fine Arts policies. I understand that the parent/legal guardian(s) assume all risk and further understand that my child could be injured while participating in a particular activities’ drills or games. I hereby authorize the Nazarene Recreation and Fine Arts Academy staff to act for me according to their best judgment in any emergency requiring medical attention if I am not present. I hereby give permission for my child’s image and likeness to be recorded and used in publications, advertising and productions of Nazarene Recreation and Fine Arts, including but not limited to photos and audio and visual recordings. I hereby waive and release all Nazarene Recreation and Fine Arts staff and Chicago 1st Church of the Nazarene from any responsibility for accidental injury while participating in any activity.

Father's Name 

Mother's Name 

Guardian Name 

I am the participant's Father, Mother or Legal Guardian (must enter one) 

Email address (this allows a confirmation email and other information to be sent to you) 

Parent or Guardian Signature (Full name) 

By entering your name on the approval line above (and then paying the registration fee) you are granting WEB approval 

Home Phone Number (format: xxx-xxx-xxxx) 

Emergency/Cell Phone (format: xxx-xxx-xxxx) 

Emergency/Cell Number Is For:

Payment Method:

PLEASE WAIT after clicking 'Continue' until the next page appears! 

PLEASE CLICK 'CONTINUE' ONLY ONCE - CLICKING MORE THAN ONCE RESULTS IN DUPLICATE REGISTRATIONS.