Please complete this registration form to get signed up. Only one form needs to be completed for each family that resides in the same household.
In the event that I cannot be reached in an emergency during the dates specified on this form, I
hereby give my permission to the physician or dentist selected by the church leadership to hospitalize, to secure
proper treatment, and/or order an injection, anesthesia, or surgery for my son or daughter, as deemed necessary.
I understand that I am signing for the minor listed on this form and the signature is for both a medical and liability release.
My electronic signature and date below constitute my consent. I understand that I may submit a paper copy of this form in place of using an electronic signature.