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

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 child’s 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.

Authorization for Emergency Treatment

Safety is our primary concern and precautions will be taken. I, the parent/guardian named below, authorize Trinity Pentecostal Church Personnel to provide basic first aid care as necessary, (ie. bandages, icepacks). Should my child(ren) require more care, I authorize Trinity Personnel to call 911 and consent to transporting my child(ren) via ambulance to receive necessary treatment.

Privacy

This information is retained as part of our confidential records, as required by law.

I agree to the Authorization to Participate statement:

YES

Parent/Guardian (electronic) signature:

Date: