Number of children to be registered:*12345Child 1 InformationChild 1 Name* First Last Child 1 Birth Date* Month Day YearChild 1 Allergies/Dietary Restrictions/Health Concerns*Please list.Child 2 InformationChild 2 Name* First Last Child 2 Birth Date* Month Day YearChild 2 Allergies/Dietary Restrictions/Health Concerns*Please list.Child 3 InformationChild 3 Name* First Last Child 3 Birth Date* Month Day YearChild 3 Allergies/Dietary Restrictions/Health Concerns*Please list.Child 4 InformationChild 4 Name* First Last Child 4 Birth Date* Month Day YearChild 4 Allergies/Dietary Restrictions/Health Concerns*Please list.Child 5 InformationChild 5 Name* First Last Child 5 Birth Date* Month Day YearChild 5 Allergies/Dietary Restrictions/Health Concerns*Please list.Parent/Guardian Contact InformationParent's/Guardian's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneCell Phone*Email* Second Parent's/Guardian's Name (if applicable) First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneCell PhoneEmail Emergency Contact InformationName* First Last Relationship to child*Home PhoneCell Phone*Medical InformationName of Health Insurance Company*Policy Number*Medical Consent* I authorize medical treatment for my child in case of accident or illness if the parent/guardian cannot be located and an emergency situation arises.Media ReleaseMedia Release* I give permission to use my child's name, photograph, and/or performance recordings (including audio and/or video forms) in brochure, web, and other promotional materials.Health AgreementI agree to the following:* It will be each parent’s responsibility to ensure their child is well and free of fever before attending Kindertreff events. If your child is not feeling well or has a fever of 100 degrees F or higher, Deutsche Kirchengemeinde Miami requests that they remain home until their fever has ended. Further, should anyone in your family have a positive COVID-19 test before or after attending a Kindertreff event, please email germanministry@gablesucc.org. Your communication will be private and your confidentiality will be protected.Other InformationAnswering these questions is voluntary.Religion/Church Member of:Is your child/Are any of your children baptized? Yes NoIf yes and you are registering more than one child, please list the names of those who are baptized.Are you interested in “Religionsunterricht” (Sunday school) in German Language? Yes NoSignatureParent's/Guardian's Digital Signature*Date* Month Day Year