BeFree Kids Ministry Form

Family Information

Family Last Name

Address

Mother's Name:

Home Phone

Cell Phone

Mother's Email

This address will receive a confirmation email

Father's Name

Cell Phone

Father's Email

Child's Information

Name

Birthdate

Gender:

Health Care Number:

Current Age:

Current Grade:

Allergies:

If yes, please list.

Special Needs or Medical Concerns:

If yes, please list or describe.

Any medications?

If yes, please list.

I would like to register my child in:

Nursery BeFree Kids

Activity, Liability and Publicity Release

Your child will be cared for as if he/she were our child. Every precaution is taken for the safety and good health of your child, but in the event of sickness, injury or death, Brooks Evangelical Free Church, it's staff and it's volunteers are hereby released from any liability.

Inflatables Liability Release
I acknowledge and agree to indemnify and hold the staff, board, volunteers and agents of Brooks Evangelical Free Church from and against any loss, damage or injury suffered by the child named above as a result of being part of the activities of the Brooks Evangelical Free church, including but not limited to the use of inflatables, as well as any medical treatment authorized by the supervising individuals representing the church.

Publicity Release
We enjoy taking pictures/video to help promote our programs and to show others what happens in our Children's Ministry at Brooks Evangelical Free Church. Promotional material may range from presentations in our church, pamphlets, to public posters, or for use on our church webpage. The statement below grants us that permission.

I give permission to the staff and volunteers of Brooks Evangelical Free Church to take photographs and/or audio-video recordings of my child and for these photos and/or recordings to be used for future promotion of Brooks Evangelical Free Church and it's activities.

Opt Out If you would like to opt out of your child being in promotional materials, please check this box.

**All video recordings during the church service will include your child if they are on stage, this includes kids choir.

Email Address Use

We will be using email to forward updates and schedules for parents and volunteers in our Children's Ministries. Please be aware that the email address you give us is the one that will be the primary email address used.

Parent/Guardian Authorization

I represent that I am the parent/guardian of the above child, who is under 18 years of age. I have read the above permission/waiver form and am fully familiar with the contents thereof. I give permission for the child name above to participate in the activities of BeFree Kids. In consideration for alllowing the participation of the child in the activities of BeFree Kids, I hereby consent to the permission/waiver form, including the Release of Liability above, on behalf of the child, and agree that this permission/waiver form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns. I also understand that it is my responsibilty to see that the information on this form is updated when there are changes in my child's/youth's medical status, etc.

Checkbox:

By checking this box, I am indicating that the above information is accurate.

Electronic Signature

By entering my name in the box above, I am providing my digital signature on this Form

BeFree Kids Ministry Form

Description

Please Fix the Following