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AFRC Emergency Contact & Child Sign Out List

  1. CoA-Logo-Color-Horizontal
  2. Alamogordo Family Recreation Center
    Please complete prior to participation in AFRC youth program.
  3. Change in Information*
    I agree to notify program staff of any changes to the information given on this registration form including medical, physical and emotional health issues and/or custody arrangements.
  4. Emergency Contacts
    Please provide emergency contact information in case parent/guardian cannot be reached in an emergency situation.
  5. (As listed on photo ID)
  6. Child Sign Out List
    Please list the individuals other than parents/guardians that have permission to sign out your child from our Youth Programs. (Note: Will be required to show valid photo ID)
  7. Field Trip Release*
    I will allow my child to accompany the Alamogordo Family Recreation Center on program-related field trips and events. I am aware children are transported in AFRC vans driven by AFRC staff. I am aware that I will be informed of these field trips on a weekly basis. I have read this release and understand its terms. I execute it voluntarily and understand that, in exchange for the participant being allowed to participate, I am waiving certain rights that the participant and/or I may have.
  8. Media Release*
    I give permission for COA/AFRC staff to take my child's photograph or video which may be used on the City of Alamogordo's public website, in print, electronic media and/or community newspapers for the promotion of COA/AFRC programs and services.
  9. Consent to Sign Electronically
    The parties agree that this agreement may be signed electronically. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
  10. Opt-out Clause
    You may withdraw your consent to receive/provide electronic documents, notices, or disclosures at any time. In order to withdraw consent, you must notify the AFRC that you wish to withdraw consent and request that your future documents, notices and disclosures be provided in paper format.
  11. Leave This Blank:

  12. This field is not part of the form submission.