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June 24-28

Ages 3 - 7th Grades

6:00pm - 8:30pm

Submit one form per child

Who is approved to pick up child? (Child Will Not be released to anyone else unless listed below)

If yes please list below. Please send along a snack for each night. Be sure their name is on all containers.

Allergies

If yes please explain below.

Medical Concerns

Every activity sponsored by this church is carefully planned and adequately supervised by mature adults. However, even with the best of planing and precaution, unforeseen events can occur. By signing this form, the parent/guardian agrees to assume and accept all risks and hazards inherent in church-related social activities. They also agree not to hold this church or its employees and/or volunteers liable for damages, losses or injures to the person or property undersigned. The parent(s) or guardian(s) understand that they are signing for the minor listed on this form and the signature is for both medical and liability release.

Thanks for submitting!

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