Kids’ Ministry Child Registration and Waiver

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Home Phone

(###)

###

####

Mom's Cell *

(###)

###

####

Dad's Cell *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Today's Date *

MM

DD

YYYY

Child 1 Name *

First Name

Last Name

Child 1 Birth Date *

MM

DD

YYYY

Child 2 Name

First Name

Last Name

Child 2 Birth Date

MM

DD

YYYY

Child 3 Name

First Name

Last Name

Child 3 Birth Date

MM

DD

YYYY

Photo Release: I give Harvest Lane Alliance Church the permission to photograph my child and use his or her picture solely for the church's website or Facebook page. Harvest Lane Alliance Church will never publish a child's name with any of its publications. *

Yes, I give permission.

No, I do not give permission.

Waiver: I acknowledge the contagious nature of the Coronavirus/COVID-19. I further acknowledge that Harvest Lane Alliance Church's Kids' Ministry has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that HLAC's Children's Ministry cannot guarantee that my child(ren) will not become infected with the Coronavirus/COVID-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to HLAC's Children's Ministry. I permit my child(ren) to voluntarily participate in events provided by HLAC's Children's Ministry and acknowledge that I am increasing their risk of exposure to the Coronavirus/COVID-19. I acknowledge that they must comply with all set procedures to reduce the spread while attending. I hereby release and agree to hold HLAC's Children's Ministry harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of HLAC's Children's Ministry, or that may otherwise arise in any way in connection with any services received from HLAC's Children's Ministry. I understand that this release discharges HLAC's Children's Ministry from any liability or claim that I, my heirs, or any personal representatives may have against the church/Children's Ministry with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from HLAC's Children's Ministry. This liability waiver and release extends to HLAC's Children's Ministry together with all members and the chartering organization (Harvest Lane Alliance Church).

I agree.