Word of Life Club Registration 2018-19
Word of Life Clubs is open to children in K5-5th Grades
Please plan for your student to wear sneakers/gym shoes EVERY Wednesday
Mother Last Name *
Your answer
Mother First Name *
Your answer
Address
Your answer
Mother Email Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Father Last Name *
Your answer
Father First Name *
Your answer
Address
Your answer
Father Email Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Do you attend church regularly?
If yes, where?
Your answer
Child #1 Last Name *
Your answer
Child #1 First Name *
Your answer
Grade *
Your answer
Age *
Your answer
Allergies or special needs? *
If yes, explain:
Your answer
Quiet Time Book
Child #2 Last Name
Your answer
Child #2 First Name
Your answer
Grade
Your answer
Age
Your answer
Allergies or special needs?
If yes, explain:
Your answer
Quiet Time Book
Child #3 Last Name
Your answer
Child #3 First Name
Your answer
Grade
Your answer
Age
Your answer
Allergies or special needs?
If yes, explain:
Your answer
Quiet Time Book
Club Fees | $10
Total Cost
Your answer
I consent to the terms of the publicity waiver *
Required
Publicity Waiver
Milford Bible Church is a nonprofit organization dedicated to Bible teaching.

I would like to help Milford Bible Church to further its charitable mission by allowing it to use the Materials (defined below) as described in this document. By signing below, I, the participant (or the participant’s legal guardian) agree that:


Consent
To help Milford Bible Church further its mission, I consent to the use by MBC of statements, voice, image, and likeness, in any format, including photos, film, video, audio, print, or electronic (together, the “Materials”), and grant to MBC the unrestricted, perpetual, and worldwide right and license to use the Materials as MBC determines, in its sole discretion, is appropriate to promote and otherwise carry out its mission. I agree that MBC may make the Materials available on its websites, in its publications, or through any other media, including social networking platforms. I understand that I am not entitled to inspect or approve the use of the Materials, receive notice of their use or publication, or receive any payment.

Milford Bible Church’s Rights in the Materials
I grant to MBC all copyrights and other rights I may have in the Materials. I acknowledge
and agree that MBC owns the physical Materials, as well as the content, any ideas or
information they may generate, and the right to copy, edit, change, transfer, create derivative
works of, or otherwise use the Materials as MBC sees fit. I confirm that I have all the rights
and licenses necessary to make these grants. I understand that MBC is not obligated to
exercise any of the rights granted under this document.


[Revoking My Consent
I understand that I may revoke my consent at any time by sending a written notice to MBC’s
Coordinator of Communications and Marketing. Following receipt of the notice, MBC will use
reasonable efforts to promptly discontinue use of the Materials.]

Waiver of Legal Claims
I waive and release Milford Bible Church, its directors, officers, employees, agents, and assigns from any legal claims, including any claims relating to copyright, rights of publicity or privacy, false light, or moral rights that I may have in the Materials or MBC’s use and ownership of the
Materials.
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I have been given a full opportunity to review and ask questions about this document. I fully
understand all of the terms of this document and sign it voluntarily and knowingly.

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