For: Girls ages 8-12 Date: Saturday, October 13thTime: 12 noon until 2:30 pm Where: Hempstead First Baptist Fellowship Hall445 Main Street, Hempstead, TXClick for Map Parents MUST register child/children in order for her/them to attend.Lunch will be served. Let's Get Crafty Registration Contact InformationYour Name*Parent or Guardian First Last Your Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Phone NumberYour Email Address* Your Child's InformationHow many children are you registering?*123456Name* First Last Age*Name* First Last Age*Name* First Last Age*Name* First Last Age*Name* First Last Age*Name* First Last Age*Special ConditionsPlease list any allergies or medical conditions for any child, and let us know which child these apply to.How will your child/children get home after the event?*AMOL will NOT be providing transportation for this event. Let us know if they will be picked up by car, if they will walk home, or other (please specify)Others ResponsibleThis is in case you cannot be reached in an emergency and/or who has permission to pick up your child(ren). Name* First Last Phone*Relationship*Name First Last PhoneRelationshipConditionsPlease click Yes for each of the fields below to register your child(ren).Condition 1*We/I the lawful parent/s or guardian/s of the minor child/children named above, give permission for the child/children to participate in activities and release from all liability and indemnify AMOL: A Message of Love, Inc. and its founder, directors, employees, teachers, volunteers, and partners from any and all liability, claims, judgments, cost or expenses, including attorney fees arising or of any damage, injury or illness incurred or caused by our/my child participating in or traveling to or from the activity, or otherwise in the organization’s custody. We/I understand the risks in these activities, including the possibility of unforeseen hazards, serious injury or death. We/I certify our/my child/children is able to participate in the activities. NoYesCondition 2*We/I agree to instruct our/my child/children to cooperate with AMOL: A Message of Love, Inc. and its representatives in charge of classes and activities and understand our/my child/children may be prohibited from participating for any failure to meet the expectations established by the organization.NoYesCondition 3*We/I appoint AMOL: A Message of Love, Inc. representatives who are acting as leaders, as our/my attorney in fact to act for us/me in our/my name and our/my behalf, in any way that we/I could act if we/I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity, related travel or while our/my child/children is/are in the organization’s custody. a. To give any and all consents and authorizations to any physician, dentist, hospital or other persons or institutions pertaining to any emergency transportation, medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions for the best interest of the child. b. We/I understand AMOL: A Message of Love, Inc. will make a reasonable attempt to contact us/me as soon as possible in the event of a medical emergency involving our/my child. NoYesCondition 4*We/I agree that AMOL: A Message of Love, Inc. may freely use our/my child/chilren's and/or our/my own name, voice, portrait, photograph or image for promotional, website, office or any other AMOL related purposes. These may be used in any broadcast, telecast, digital or print medium, including video images, photographs, pictures or renderings, audio recordings, or other likenesses, in combination or alone without any compensation.NoYesYour Signature*Please sign with your finger or mouse in the box.