Truth Tabernacle

KIDZ POWERED BY JESUS 2020-2021

KPBJ CLUB REGISTRATIONpage 1 of 1

PLEASE COMPLETE ONE FORM FOR EACH CHILD.

Intended for children TK-6th Grade as of September 1.

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Address
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Address
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Email Address
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AUTHORIZATIONS

I hereby attest that I am (we are) the legal parent/guardian(s) of the above-named child and hereby consent to the child's participation in the activities described. I understand that activities of the kind described may result in physical injury to my child. Knowing this, I grant permission for my child to participate in those activities.
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Walk
Run
Jump
Play games with balls, sticks, ropes, material or other game type items
Use scissors
Use glue
Use paint
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I agree
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Yes
No

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Phone Number

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Phone Number
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Yes
No



LIABILITY RELEASE | MEDICAL INFORMATION | IN CASE OF EMERGENCY INFORMATION |

As a parent and/or guardian, I do herewith authorize treatment under the direction of any licensed physician of the following minor in the event of a medical emergency which in the opinion of the attending physician may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me by phone at the number listed below. The undersigned assumes the responsibility for any costs connected with such treatment and I (we) hereby releases Truth Tabernacle staff, leaders, or directors of the Kidz PBJ Club from any liability. This release form is completed and signed of my own free will for the purpose of authorizing medical treatment under emergency conditions in my absence. This release form is in effect for any and all Kidz PBJ activities from this day forward. As the undersigned, I also waive any claims against Truth Tabernacle and its volunteers for damage or injury to the person or property of my child while involved in all activities, both on or off the church premises.
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I agree

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Phone Number



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