Rehoboth Moms Childcare
Please register your child(ren) below for childcare
Parent/Guardian Name *
Your answer
Parent/Guardian Address *
Your answer
Email *
Your answer
Mobile Phone *
Your answer
Child's Name *
Your answer
Child's Age *
Your answer
List any allergies/special needs your child has: *
Your answer
May we have permission to photograph your child for promotional purposes? *
When you worship, where do you attend?
Your answer
Waiver: *
In consideration for the opportunity to participate in this program of Rehoboth Baptist Church, the undersigned, on his/her own behalf or as parent/legal guardian of the participant, hereby expressly and voluntarily agrees to assume all risks, whether known or unknown. The undersigned, on his/her own behalf or as the parent/legal guardian of the participant, further agrees and covenants, not to sue and to hold harmless and forever release, waive, and discharge the Rehoboth Baptist Church, its legal representatives, successors, agents or employees, from any and all liabilities, claims, demands, actions, causes of action, losses, debts, sums of money, suits and damages, arising out of any injury which the participant and his/her parents, heirs, executors, administrators, successors and assigns, may have sustained by participation in the recreation program or children's ministry of Rehoboth Baptist Church whether caused, in whole or in part, by the acts, omissions, or negligence of the releases or otherwise. I HAVE READ THE ABOVE GENERAL RELEASE AND LIABILITY WAIVER AND UNDERSTAND THAT I FOREVER WAIVE CERTAIN RIGHTS BY SIGNING IT AND DO SO VOLUNTARILY.
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