BC Kids Church Registration

Family Information

Parent/Guardian Information:(Required)
Click the + to add more parents/guardians
First & Last Name
Primary Phone
Email Address
Relationship to child(ren)
 

Children's Information(Required)
Click the + to add more children
Child's First & Last Name
Child's Date of Birth
Child's Grade by 9/2022
Allergies/Special Needs
 

Home Address(Required)


Emergency Information

Doctor Information(Required)
Doctor's Name
Doctor's Phone Number

Emergency Contact (Other than parents)(Required)
Name
Relationship to child(ren)
Phone Number

Release Authorization
If a parent is not able to pick up their child(ren), please designate who may pick up your child(ren) in your absence. I give my permission for my child(ren) to be picked up from Children’s Ministry Programs by the following person(s):
Name
Relationship
Phone
 


CONSENT TO TREAT:

By signing below, I hereby give my permission to the physician selected by the Bear Creek United Methodist Church trip coordinator, or adult in charge, to order X-rays, routine tests, and provide treatment for the health of my child, in the event of a medical emergency. Bear Creek United Methodist Church may hospitalize, secure proper treatment, order injection(s) and/or anesthesia, and/or surgery for my child as named in this document in the event that the parents and emergency contact cannot be reached.

TRANSPORTATION RELEASE:

By signing below, I authorize transportation for my child by emergency vehicle to an appropriate health care facility and pre-hospital medical care center. I authorize all hospital and physician services, whether medical, surgical and/or dental, deemed necessary for the benefit/safety/well-being of my child(ren).

HOLD HARMLESS AGREEMENT:

By signing below, I, knowing that Bear Creek United Methodist Church has general liability coverage, understand that no accident policy is being carried out for this program and do assume all risks and hazards incidental to the conduct of its activities. I do further indemnify and hold harmless the Bear Creek United Methodist Church, the organizers, sponsors, volunteers, drivers, and workers associated with church sponsored events and activities. In case of injury to my child(ren), I hereby waive all claims against Bear Creek United Methodist Church, the organizers, sponsors, volunteers, drivers, and workers associated with church sponsored events and activities.

PHOTOGRAPH RELEASE:

By signing below, I grant permission for photographs, video, and audio recordings of my child(ren) while he or she participates in the activities associated with Bear Creek United Methodist Church, and I agree that Bear Creek United Methodist Church shall own all rights, copyrights, and derivative works. I give my irrevocable and perpetual consent to Bear Creek United Methodist Church to use, distribute and publish the photographs, videos, and audio recordings of my child for internal and promotional purposes, including posting at the church, broadcasting as audio programs, displaying as slide show or video presentations, inclusion in printed materials, and inclusion in online publication, presentations, and social media sites, such as, Facebook, Twitter, and YouTube.


I have read and agree to the above statements.(Required)