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Cornerstone Children's Ministry Registration 2017-2018
Last Name *
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First Name *
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Child's Nickname
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Gender *
Birthdate (m/d/yr) *
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Class fall of 2017 *
Parent Name(s) *
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Phone *
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Street Address *
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City *
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Zip *
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Email *
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Medical Info/Allergies (indicate NA if none) *
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PHOTOGRAPH / VIDEO USE CONSENT AND RELEASE I hereby grant permission to Cornerstone Community Church, its representatives, contractors, employees and volunteers acting on behalf of the ministry, to take and/or use, copyright, publish, edit, crop or treat images or likenesses of me or my child(ren), including photographs, videos or otherwise , of me or of my child(ren), for any lawful use on the ministry’s website, social media pages, blogs, or in other official ministry printed or electronic publications without further consideration. I understand that this consent and release will operate in full force and effect until such time as I withdraw my consent in writing. I understand that should photographs or videos of me or my child(ren) be used on Cornerstone Community Church owned or operated websites or webpages, they may be available for download. I do hereby agree to release, indemnify, and hold harmless Cornerstone Community Church and its agents and employees, harmless from any and all present, past, future, known and unknown liabilities, actions, causes of actions, claims, expenses, and damages that may arise from the use or dissemination of photographs or videos of me or my child, whether via the internet or in print. I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted in the State of Ohio and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I also agree that any controversy or claim, by or through the party signing this release, arising out of or relating to the activities anticipated by this form shall be settled by binding Christian arbitration conducted by the National Center for Life and Liberty or another Christian arbitrator, and judgment on the award may be entered in any court having jurisdiction thereof. Indicate your agreement by typing your name below: *
Date *
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Please type your name below to consent to your child participating in Cornerstone Community Church's Sunday morning Children's Ministry classes. *
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