KUC Cubs Game Sign Up
This form must be returned to the church by August 9, 2009 with a check payable to ‘Kenilworth
Union Church’.
Participant’s
Name:_________________________________________
Grade:________________
Date of birth:_____________________
Address:_______________________________________________
City:____________________
State:________ Zip:_____________
Phone: (home) _______________ (student cell) _______________
Youth Email: __________________________________________
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Parent Name:___________________________________________
Address (if different):_____________________________________
City:____________________
State:________ Zip:_____________
Phone: (home) _______________ (parent cell) ________________
Parent Email: ___________________________________________
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Cost
per participant: $50 This covers
the ticket to the game and two train rides. Please send your son or daughter with extra money for food,
snacks or souvenirs.
Parental
Permission / Release
I give permission for my son/daughter named above to go to the Cubs game on August 16th
with the Kenilworth Union Church Youth Ministries Staff. You have advised me of the nature of the
proposed activities, the transportation and the supervision available and I consent fully to my child’s participation.
I understand there are inherent risks involved in any such activities, and I release the Church and all of its agents
from any claim, whatsoever, arising out of this activity. I accept responsibility for any damage caused
by my child’s negligence or intentional act.
Parent/Guardian Signature: ______________________________Date: _____________
