Montana Organic Association

Kids’ U Registration form and Release

Montana Organic Association Kids' U Sign Up

Kiddo Info

Parent Info

Health and Other Info

Permissions

Kids' U Registration Form and Release

Kids' U is a chance for kids aged 4 - 12 to learn more about regenerative organic agriculture on Friday, December 6, 2019. It is organized and staffed by MOA volunteers. Registration fee is $10 for each child to help cover costs for food and program supplies.

Kiddo 1- Name

First Middle Last

Kiddo 1 - Birthdate

MM

DD

YYYY

Kiddo 2 - Name

First Middle Last

Kiddo 2 - Birthdate

MM

DD

YYYY

Kiddo 3 - Name

First Middle Last

Kiddo 3 - Birthdate

MM

DD

YYYY

Kiddo 4 - Name

First Middle Last

Kiddo 4 - Birthdate

MM

DD

YYYY

Parent 1 - Name

First Middle Last

Parent 2 - Name

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

We recognize that a family may have more than one address; in this case, we only require one of those addresses.

Parent 1 Phone

Parent 2 Phone

Parent 1 Email

Parent 2 Email

ACTIVITY RESTRICTION(S):

Identify your kiddo and let us know if there are any activities they should be restricted from.

ALLERGIES, PHYSICAL, MENTAL OR OTHER CONDITION(S):

Identify your kiddo(s) and let us know if they have any conditions that require special attention.

ADDITIONAL COMMENTS:

Please let MOA know of any additional information that will help your child(ren) have a good experience with Kids' U. (Nicknames, likes, dislikes, etc.)

Release

List anyone, including parents, to whom your kiddo(s) can be released.

Consent

By consenting to this registration, you agree that you are the parent or legal guardian of the above-named child(ren), and are over 18 years old. In the case of a medical emergency or general medical care, you give consent for medical treatment for the above-named child(ren) by authorized personnel. MOA carries secondary insurance. You understand that the above-named child(ren) will only be released to the names listed in the "Release" section, an update may be done on-site, the day of Kids' U. You certify that your child(ren) has permission to attend Kids' U and participate in all activities. You authorize the Montana Organic Association to use your child(ren)'s photos, testimony, and video in any promotional material (web, print, or media).

I consent to let my child(ren) participate in the Montana Organic Association Kids' U program.

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