2017 Children's Registration for Special Conference (Copy)

2017 Children's Registration for Special Conference (Copy)

Form for children registration for 2017 Special Conference Form Preview
2017 Children's Registration for Special Conference (Copy)
  • 2017 SPECIAL CONFERENCE

    February 17-19

    Children Registration & Medical Release Form

    (please fill out one form for each child)

  • Please Note: Child must be 5 years old and in Kindergarten

  • Allergies

    (if none please write "NA")

  • Special Needs

    (if none please write "NA")

  • Authorizations

    Alternate Responsible Ones: In the event of an emergency or illness with our child we authorize the serving ones to contact the following alternate responsible persons who are over the age of 18. We also authorize these persons to pick up our child from Children's Service:

  • Emergency Medical Services: We also authorize the responsible ones in the Children's Service to call an emergency ambulance in the event of my child's accident or acute illness, and to arrange for necessary emergency medical or surgical care if I am not immediately available. It is understood that a conscientious effort will be made to notify either myself or the persons designated above, before such action will be taken.

    Liability Release: We agree to hold harmless and indemnify Living Stream Ministry, APCC, the church in Anaheim, the local church in which I am a member, and any of the other affiliated local churches or church affiliated organizations, members, serving ones, responsible adults, or volunteers present at the event referenced above, from any and all injuries, claims, damages, liability, costs and expenses including, but not limited to, attorneys' fees, litigation expenses, court costs, and all other sums which the persons and organizations referenced above may pay or become obligated to pay on account of any, all and every demand for claim or assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of the 2017 Special Conference involving my children.

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