2023-2024

Children’s Church Registration

Registration Form

(If you have more than 1 child to register please fill out 1 form per child)

Parent's Name

First Name

Last Name

Phone

(###)

###

####

Address

Child's Name

First Name

Last Name

Birthday

YYYY

Age/Grade

6 months+

Select

Does your child have any allergies?

Text Area 1

Please list allergies if applicable.

Does your child have special learning needs?

Emergency Contact Name

First Name

Last Name

Emergency Contact Number

T-Shirt Size

I do hereby release, forever discharged and agree to hold harmless the Living Rock Church Ministry, personnel, workers, counselors and the directors thereof from any liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating in the above-described trip or activity including recreation and work activities. The undersigned further hereby agrees to hold harmless and indemnify said church said church, its directors, employees and agents for any liability sustained by said acts of said participant, including expenses incurred attendant thereto. The undersigned further consents to the administration of first-aid and/or doctor’s care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the necessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemnify said church, its directors, employees, and agents from any act of malfeasance, and/or failure to act on the part of those chosen to administer medical care on behalf of the participant.

There is inherent risk in attending any group event; if you or your child are at risk for COVID19, please take that into account when making your decision to attend. If your child or any other family member is showing symptoms of COVID19 (fever, cough, shortness of breath), please stay at home.