Episcopal Diocese of Oregon Diocesan Convention

Child Care Information/Registration/Release

We are pleased to announce that the Diocese of Oregon will be offering child care for this year’s Diocesan Convention at no cost. Child Care will be available at the following times and locations:

  • Thursday, October 26, from 6pm to 8:30 pm at St. Paul’s Eugene
  • Friday, October 27, from 8am to 12:30pm and 2pm to 5:30pm at the Salem Convention Center
  • Saturday, October 28, from 8am to 12:00pm at the Salem Convention Center

The registration deadline for child care is October 12 2017. To register your child, please complete this form and mail to: Child Care Registration

Diocese of Oregon

11800 SW Military Lane

Portland, OR 97219

For further information, please contact Tracy Esguerra at or by calling 971-204-4101 or 1-888-346-2373

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Person who will be bringing child (children) to convention______

E-mail address______

Homephone number______Cell______

Name of parent or guardian if different from above______

E-mail address______

Home phone number______Cell______

Name of emergency contact______

E-mail address______

Home phone number______Cell______

Please note: Parents need to provide diapers, underwear, change of clothing, food and snacks for their children. In order to provide a break for our caregivers, parents are responsible for caring for their children during the Friday lunch adjournment. Also, if your child will be napping during their time with us, please provide a blanket with a sleeping mat or portable crib.

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Episcopal Diocese of Oregon Diocesan Convention

Child Care Information/Registration/Release (cont.)

1. Child’s full name______Nickname______

Age______Date of Birth______Grade______

Food allergies, medical conditions or other special needs:

______

I wish to register this child for child care at the following times and locations:

Thursday, October 26, 6pm to 8:30pm at St. Paul’s, Salem

Friday, October 27, 8am to 12:30pm at the Salem Convention Center

Friday, October 272pm to 5:30pm at the Salem Convention Center

Saturday, October 28, 8am to 12:00pm at the Salem Convention Center

2. Child’s full name______Nickname______

Age______Date of Birth______Grade______

Food allergies, medical conditions or other special needs:

______

I wish to register this child for child care at the following times and locations:

Thursday, October 26, 6pm to 8:30pm at St. Paul’s, Salem

Friday, October 27, 8am to 12:30pm at the Salem Convention Center

Friday, October 27 2pm to 5:30pm at the Salem Convention Center

Saturday, October 28, 8am to 12:00pm at the Salem Convention Center

3. Child’s full name______Nickname______

Age______Date of Birth______Grade______

Food allergies, medical conditions or other special needs:

______

I wish to register this child for child care at the following times and locations:

Thursday, October 26, 6pm to 8:30pm at St. Paul’s, Salem

Friday, October 27, 8am to 12:30pm at the Salem Convention Center

Friday, October 27 2pm to 5:30pm at the Salem Convention Center

Saturday, October 28, 8am to 12:00pm at the Salem Convention Center

I give permission for the above-named children to participate in child care during the 2017Diocese of Oregon pre-convention and convention as indicated. I do hereby release, hold harmless and covenant not to sue the Episcopal Diocese of Oregon, St. Paul’s Episcopal Church, the Salem Convention Centerand all employees and volunteer leaders involved in these events. Nor shall said persons be held financially responsible for any injury, illness, or death incurred as a direct result of these activities. I recognize the risks involved, understand all terms, and consent to these conditions. I remain fully liable for any legal responsibilities that may result from actions taken by my child(ren). I give permission for my child(ren) to be photographed participating in this event with the understanding that he/she will not be identified by name. In the event of an emergency, and I cannot be contacted, I hereby authorize emergency treatment to be administered.

Signature of parent of guardian______Date______