faf728a4-a63b-4cb5-8e6f-09407dea4397.jpg

KidFest Registration

July 22, 2018 - July 26, 2018

 

Please complete the form below

Parent Information
Name *
Name
Phone
Phone
Emergency Contact
Emergency Contact
Emergency Phone
Emergency Phone
Children(s) Information
Child Name
Child Name
Physical limitations (asthma, diabetes, allergies, etc.) and/or special instructions (allergic to certain meds, rare blood type, wears contact lenses, etc.)
Child Name 2
Child Name 2
Child Name 3
Child Name 3
Liability Release
The Health History is correct so far as I know, and the person herein described has permission to engage in all prescribed activities. During church events and activities, if media is taken by the church or its designees, I give full rights of the media in question for the marketing, publication and dispensing at their discretion. I hereby give permission to medical personnel selected by Greenwood Christian Church sponsor/designee to order X-rays, routine tests and treatment as prescribed. In the event of an emergency and neither my primary contact nor secondary can be reached, I hereby give permission to the physician selected by the Authorized Agent to hospitalize, secure proper treatment, order injections and/or anesthesia and/or surgery on my behalf. I further authorize the release of the above medical information to appropriate medical personnel and/or the health coverage insurance company. In addition, I have, and do hereby, release the church, its employees or agents from liability associated with participation in a church activity.
Date *
Date