Parent/Guardian Name
Street Address
Mailing Address
CIty State Zip
Cell Phone Other Phone
Email
Child 1 Gender Age Grade T-shirt size
Child 2 Gender Age Grade T-shirt size
Child 3 Gender Age Grade T-shirt size
Please indicate any medical issues we should be aware of. (Please include any food allergies)
Emergency and Liability Information 2019
I give permission for my son/daughter to participate in Summer Blast July 14 - 19, 2019. I release Grace Bible Church and any volunteer staff of this church from all claims of damage, demands, or actions in any manner arising or growing out of my son’s/daughter’s participation under the ministry of Grace Bible Church.
Medical Release: “In the event that I cannot be reached in an emergency during Summer Blast, I hereby give my permission to the physician or dentist selected by the Grace Bible Church’s leadership to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary.”
Liability Release: Every activity sponsored by this church is carefully planned and adequately supervised by mature adults. However, even with the best planning and precaution, unforeseen events can occur. By signing this form, the parent or guardian agrees to assume and accept all risks and hazards inherent in this event. They also agree not to hold this church (Grace Bible) or its employees or volunteer assistants liable for any injuries to the person undersigned. The parents or guardians understand that they are signing for the minor listed on this form and the signature is for both medical and liability release.
Valid July 14, 2019 through July 19, 2019
Please read the above information and indicate your agreement.
I agree to the above medical and liability releases (Yes or no)
Name Phone
Name Phone Relationship
Is your child/family actively involved in a church? (Yes or No)
If so, what church?
How did you hear about Grace Bible Church's Summer Blast? (facebook, Ledger, Friend, etc)
Have your kid(s) attended one of our summer programs in the past? (Yes or No)
May we have permission to photograph your child participating in Summer Blast activities? (Yes or No)
May we use your child's photo in future Summer Blast promotions? (Yes or No)
Summer Blast Registration is $10.00 for the first child. Each additional child from the same household is $5.00.
After submitting this form you will be redirected to the Grace Bible Church secure gateway for payment.
