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REGISTRATION FORM

Child's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Your Name (Name of Parent or Legal Guardian Registering) *

First Name

Last Name

Name of Other Primary Parent/Legal Guardian *

First Name

Last Name

Primary Parent or Legal Guardian Mobile Phone *

(###)

###

####

Emergency Phone *

(not the primary phone/email contact)

(###)

###

####

PLEASE READ, COMPLETE, AND SIGN THIS PAGE *

We realize that no activity is without the possibility of unforeseen hazards, which could result in injury to an individual. For this reason, Joshua Springs Calvary Chapel provides supervision and directions for the safe conduct of activities. Sometimes these directions are not followed or are disregarded by children/teens in our ministry or activity, resulting in injury. As a parent, guardian, or other responsible person, Joshua Springs Calvary Chapel expects you to be aware of your responsibility to instruct your child(ren)/teen(s) of the importance of conduct which will ensure safety and an enjoyable time. By signing this form, you, as a parent, guardian, or other responsible person, agree to assume the risks and hazards, which may be inherent in these activities. You also agree to absolve and hold harmless Joshua Springs Calvary Chapel, and/or its owners, agents, or employees for damage, losses, or injuries to the person(s) or properties of the undersigned. I understand that I am signing for the minor(s) listed on this form and that the signature is both a medical and liability release. If an accident should occur which causes a dispute between Joshua Springs Calvary Chapel and myself, I agree not to press charges in a court of law but will submit to arbitration by a representative of an organization established for such a purpose; agreed to by both parties. In case of an emergency at the location of Joshua Springs Calvary Chapel, our procedures will be to contact the parent/guardian(s). If we are unable to reach the parent/guardian(s), the seriousness of the emergency will indicate which course of action to be taken Option 1. The person you designate on this form may be asked to care for your child(ren)/teen(s) until you can be reached Option 2. The paramedics may be called in a life-threatening situation. I hereby give my permission to the physician, nurse, or dentist selected by Joshua Springs Calvary Chapel to secure medical or dental first aid as required for illness or injury under a physician’s orders, including transportation to and from the necessary facilities.

I understand and agree with the terms & conditions

Primary Care Physician's Phone # *

(###)

###

####

USE OF PHOTO, AUDIO, AND/OR VIDEO *

The staff of Joshua Springs Calvary Chapel will be taking photos, audio files, or video images during VBS of your child/teen for sharing information about our ministry and mission for worship on our website or in other types of non-commercial promotions. Student, staff, and volunteer photos, audio files, and/or video images of my child(ren)/teen(s) will be used for promotions at Joshua Springs Calvary Chapel.

I understand and agree with terms and conditions