TPC Kid's Ministry

TPC Kids Registration

I am registering my child for: *

Child's Name *

Child's Birth Date *

Grade (as of September) *

Allergies/Medical Information (Anything we should know?) *

Will your child be bringing an EpiPen or Inhaler?

Yes

Home Address *

City *

Postal Code *

Parent's Name *

Parent's Cell Number *

Parent's Email Address *

Is there anything else we should know about any of your children to ensure their safety and to help them have fun?

In case of an emergency, if we can't reach the above parent(s), who should we contact?

Name *

Number *

Please list the people allowed to pick up your child(ren):

Name and relationship to child(ren):

The Fine Print:

Trinity Pentecostal Church may capture program/event photography and video footage. These may be displayed around the church for promotional purposes and/or placed on the church website/Facebook page.

My child(ren) may be photographed/recorded in accordance with the description provided.

YES

Authorization to Participate

The safety of your child(ren) is our primary concern. Precautions will be taken for their well-being and
protection.

As the parent or guardian named below, I authorize Trinity Pentecostal Church Personnel to
call 9-1-1 for the named above in case of an emergency.

My (electronic) signature on this form is my certification that the above child(ren) is physically capable
of engaging in the activities at Trinity Pentecostal Church, and I hereby give consent for my child(ren)
to participate in such. I assume all risks of injury or damages of whatever type or form associated with
my childs participation in these activities. I further agree to indemnify and hold harmless Trinity
Pentecostal Church from any and all claims arising from any injury or illness of my child during such
activities.

Trinity Pentecostal Church retains this personal information for the purpose of enrolling your
child(ren) in our programs, to assign the participant to the appropriate class(s), to develop and nurture
ongoing relationships with you and your child(ren), and to inform you of program updates and
upcoming opportunities at our Church. This information will be maintained indefinitely as it is a
requirement of our insurance company and legal counsel and maintained with strict confidentiality.

I have read, understood and agree with the above.

I agree to the Authorization to Participate statement:

YES

Parent/Guardian (electronic) signature:

Date: