Westview Kids Registration 2020-2021
Please fill out 1 form per child.
CHILD INFORMATION
Name *
Age *
School Grade *
Birthdate *
MM
/
DD
/
YYYY
Address *
Allergies or Medical Conditions (This will remain confidential, but it helps us to know how to best care for the children) *
Medicare # *
PARENT/GUARDIAN INFORMATION
Name(s) *
Email *
Cell Phone *
Home Phone *
Relationship to Child *
SECONDARY EMERGENCY CONTACT
Name *
Cell Phone *
Home Phone *
Relationship to Child *
I'm interested in information about: *
Select all that apply
Required
MINOR PHOTO/VIDEO RELEASE
Westview Bible Church periodically uses pictures and video footage to provide updates and news on our ministry programs, and for promotional purposes on our website, social media, and brochures. Do you consent to your child’s image to be included in any picture or video that Westview Bible Church uses for these purposes? *
Purposes and Extent:
Westview Bible Church is collecting and retaining this personal information for the purposes of enrolling your child in our programs, to assign the child to the appropriate class, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Westview Bible Church to limit the information collected or if you wish to view your child’s information, please contact us.
CONSENT
I/We, the parent(s) or guardian(s) named above, authorize the ministry staff of Westview Bible Church to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named above. I/We, named above, undertake and agree to indemnify and hold blameless the ministry staff, Westview Bible Church, its Pastors, Directors, and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Westview Bible Church, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization are effective only when participating in or traveling to events of Westview Bible Church. Please enter your name and date below as a digital signature. *
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