Kids of the Kingdom 2018-19
Childrens Registration and Medical Release
There are fees attached to some events, they vary with the event.
Name *
Your answer
Grade 2018-19
What School does the child attend?
Your answer
Parent Info
We love to have parents participate, Please sign up for at least one date that you are available to chaperone, drive or provide a snack. Once this form is submitted you will receive a confirmation with a link to RSVP for events .
Mother's Name *
Your answer
Email Address *
Your answer
Cell Phone Number *
Your answer
Father's Name *
Your answer
Email Address *
Your answer
Cell Phone Number *
Your answer
Can we text you event reminders & changes? *
Home Address
Your answer
**PLEASE NOTE THAT DATES ARE SUBJECT TO CHANGE OR CANCELLATION IF THERE IS INSUFFICIENT CHAPERONE PARTICIPATION BY RSVP DUE DATE.
Are you available to chaperone and/or drive on any of the following dates?
Photo Release
Ascension Lutheran Church seeks to actively promote the positive community and accomplishments of our students. In many cases, photos of our students appear in local media, our Church website and church social media pages. These guidelines are intended to protect our minor students from being specifically identified through material that is published in the media and/or posted on the Internet.
Can we take photos of your child for posting on social media and internet? *
Medical Release
Insurance Carrier *
Your answer
Plan # *
Your answer
Doctor's Name & Phone Number
Your answer
In the event a parent is not available please give us an alternative emergency contact. *
Your answer
I do hereby state that I have legal custody of the aforementioned Minor. I grant my authorization and consent for Ascension Lutheran Church (hereafter “Designated Adult”) to administer general first aid treatment for any minor injuries or illnesses experienced by the Minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designated Adult to summon any and all professional emergency personnel to attend, transport, and treat the minor and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Designated Adult in the exercise of his or her best judgment upon the advice of any such medical or emergency personnel. *
I understand the information above and by checking the box below I agree to electronically sign this form and Medical Release *
Required
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