SSBC Youth Ministry Registration 2019-2020

August 2019-July 2020 | Please fill out this form and click submit. Fill out one form for each student.
Student Information

 
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Please enter the STUDENT'S email and cell phone number below.
 
 
 
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Parent Information

 
 
 
 
 
Release of Liability, Permission for First Aid or Medical Treatment, Photography Release

By signing this permission/waiver form, I expressly assume all risks of the above mentioned child when participating in the activities, whether such risks are known or unknown to me at the time.  I further release Siloam Springs Bible Church and its ministers, leaders, employees, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities.  This release of liability shall include (without limitation) any claims of negligence or breach of warranty.  This release of liability is also inteneded to cover all claims that members of the child's or my family or estate, heirs, representative, or assigns may have against Siloam Springs Bible Church or its ministers, leaders, employees, volunteers, or agents.  I further agree to indeminify and hold harmless Siloam Springs Bible church and its ministers, leaders, employees, volunteers, or agents from any and all claims arising from my participation in its actvities and programs, or as a result of injury or illness of my child during such activities.
All effort will be made to reach a parent/guardian/emergency contact in the event of an injury or illness.
I recognize that there may be occasions where the child named above, or I, if I am a participant, may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury.  I do hereby give permission for agents of Siloam Springs Bible Church to seek and secure any needed medical attention or treatment for the child named above, or me, if I am a participant, including hospitalization, if in the agent's opinion such a need arises.  In doing so I agree to pay all fees and costs arising from this action to obtain medical treatment.
I authorize Siloam Springs Bible Church to include myself/my children in pictures for promotional purposes of events he/she is participating in.  I understand that my child's name will not be published with the pictures he/she is in.
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*By entering my name in the box below, I am providing my digital signature to this form.
 

Description

August 2019-July 2020
Please fill out this form and click submit. Fill out one form for each student.