LifeChurchFishers-Kids Clubs and LINK Registration 2019-20

Kids Clubs and LINK (preteen) Registration for 2019-20
Life Church Fishers- Sept.4, 6:30-8:00

Kids' Life Groups for children ages 4 years -8th Grade.

Question Title

* 1. Child's Information

First and Last Name:

Gender (M or F)

Birthday (00/00/0000):

Grade for 2019-20 (pre-k (4yrs) - 8th grade

Allergies

Physical/Mental/Social conditions in need of monitoring

Responses recommended for the above needs:

Question Title

* 2. Child's Information

First and Last Name:

Gender (M or F)

Birthday (00/00/0000):

Grade for 2019-20 (pre-k (4yrs) - 8th grade

Allergies:

Physical/Mental/Social Conditions in need of monitoring

Responses recommended for the above needs:

Question Title

* 3. Child's Information

First and Last Name:

Gender (M or F)

Birthday (00/00/0000):

Grade for 2019-20 (pre-k (4yrs) - 8th grade

Allergies

Physical/Mental/Social conditions in need of monitoring

Responses recommended for the above needs:

Question Title

* 4. Child's Information

First and Last Name:

Gender (M or F)

Birthday (00/00/0000):

Grade for 2019-20 (pre-k (4yrs) - 8th grade

Allergies

Physical/Mental/Social conditions in need of monitoring

Responses recommended for the above needs:

Question Title

* 5. Child's Information

First and Last Name:

Gender (M or F)

Birthday (00/00/0000):

Grade for 2019-20 (pre-k (4yrs) - 8th grade

Allergies:

Physical/Mental/Social conditions in need of monitoring

Responses recommended for the above needs

Question Title

* 6. What church (if any) does your family typically attend?

Life Church Fishers (9820 E 141st St., Fishers, IN)

Life Church Noblesville (2200 Sheridan Rd., Noblesville, IN)

Life Church Eagle Creek (5901 Lafayette Rd., Indianapolis, IN)

We do not have a home church

We currently attend another church.
(Please list church below)

Question Title

* 7. Parent/Guardian Information

Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

Question Title

* 8. Emergency Contact information

Name:

Phone Number:

Question Title

* 9. I, the undersigned, have legal custody of the child named above, a minor, and have given my consent for my child to attend events being organized by Life Church Assembly of God, Inc. (“Church”). The Church includes its Pastors, employees, agents, and volunteer workers. I understand and consent that my child may be taught Biblical principles.
* Medical Consent: If my child experiences a medical situation, and I or my emergency contact cannot be reached, I give my permission to seek whatever medical attention is deemed necessary by the Church, and transport my child by ambulance or private vehicle to the nearest medical facility. In the event that my child is injured and requires medical services, I consent to any medical treatment as deemed necessary by a licensed physician. I also acknowledge that I will be ultimately responsible for the cost of any medical services should the costs not be reimbursed by any health insurance provider. I release the Church from any and all medical services and costs.
* Release: I understand that there are inherent risks involved in any ministry or activity, and I hereby release the Church from any and all liability, loss, or damage to person or property that may occur during the course of my child’s involvement. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I agree to hold the Church free and harmless of any and all liability, claims, demands, or suits for damages arising from the giving of such consent. I also understand that photographs of my child(ren) may be taken during activities and used for "in-house" purposes as well as social media marketing.

My name and date below serve as my electronic signature to this medical release form for my child.

Name:

Date: