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Life Church

Location

6501 S. State Rd 67

Pendleton, IN 46064

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Contact Trevor Fannin:

317-938-3021

trevor@lifechurchin.com

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Información de los Padres

We are so excited for our Life Church Midweek programming for kids! The next 8 weeks will be full of adventure, fun, and an opportunity to make new friends and learn even more about God!

Nombre

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Apellido

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Correo Electrónico

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Dirección 1

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Dirección 2

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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País

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Teléfono de Contacto 1

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Teléfono de Contacto 2

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Nombre del Contacto de Emergencia

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Relación del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Nombre de recogida alternativo

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Teléfono de recogida alternativa

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Nombre alternativo de recogida 2

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Teléfono alternativo de recogida 2

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Afiliación de la iglesia local

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I would like more information on the Scholarship option for the $20 fee.

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Cuéntanos sobre tu participante

Nombre

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Apellido

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Grado Entrando

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Género

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Fecha de nacimiento

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Alergias

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Preocupaciones Médicas

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MEDICAL CONSENT AND RELEASE: 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.

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* 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 .

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* 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.

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*Release: Photography, Image and Filming Waiver: I hereby grant Life Church, it’s directors, employees, volunteers, any participants, photographers, agents, and designees (Collectively “Life Church and any associates”) non-revocable permission to capture my image and likeness in photographs, videotapes, motion pictures, recordings, or any other media (Collectively “Images”. I acknowledge that Life Church, and the photographers have dual ownership and will own such images and further grant them permission to copyright, display, publish, distribute, use, edit, print, and reprint such images in a highly respectable manner honoring God, the student, Life Church, including without limitation to publications, advertisements, brochures, website images, or other electronic displays and transmissions thereof. I understand the rights and limitations of the photographer according to the Photographer Waiver. I further waive any right to inspect or approve the use of the images by Life Church prior to its use. I forever release and hold Life Church harmless from any and all liability arising out of the use of the images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the images, including without limitation to claims for invasion of privacy rights or publicity. Parent or Legal Guardian: I hereby certify that I am the parent and/or guardian of a child under the age of 18 years, and I hereby consent that any images (as deemed above) may be used for any purposes set forth in the Authorization and release.

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By typing my name in the box below, I acknowledge that I am the legal parent/guardian of participant named above and acknowledge and agree to the release/waivers as disclosed above. Please type name below.

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