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Cornerstone Children's Ministry Registration 2018-2019
Last Name *
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Parent(s) name *
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Address *
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Email *
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Phone Number *
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Child #1 Name *
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Birthdate *
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Class fall of 2018 *
Medical Info/Allergies/Needs Special Accomodations (indicate NA if none) *
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Child #2 Name
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Birthdate
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DD
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YYYY
Class fall of 2018
Medical Info/Allergies/Needs Special Accomodations (indicate NA if none)
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Child #3 Name
Your answer
Birthdate
MM
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DD
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YYYY
Class fall of 2018
Medical Info/Allergies/Needs Special Accomodations (indicate NA if none)
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Child #4 Name
Your answer
Birthdate
MM
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DD
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YYYY
Class fall of 2018
Medical Info/Allergies/Needs Special Accomodations (indicate NA if none)
Your answer
Child #5 Name
Your answer
Birthdate
MM
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DD
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YYYY
Class fall of 2018
Medical Info/Allergies/ Needs Special Accomodations(indicate NA if none)
Your answer
If you have more children to add please submit another form. Thank you!
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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. *
Activity Consent and Release: I hereby affirm that the child(ren) listed above may participate in the Sunday Children's Ministry program. I understand and agree that neither Cornerstone Community Church, nor its trustees, respresentatives, employees, instructors or volunteers may be held liable in any way for any occurrence in connection with my child(ren)'s participation. I further agree to save and hold harmless Cornerstone Community Church, its trustees, respresentatives, employees, instructors or volunteers from any claim by me or my family, estate, heirs or assignees arising out of my child(ren)'s participation. I also authorize Cornerstone Community Church to render or obtain emergency medical care or treatment as may be necessary should any injury, harm or accident occur to my child(ren) while participating in the activity. I further state and acknowlege that I have fully read the foregoing release and know the contents thereof and I sign this release as my own free agent. *
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Date *
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