Kids Valentine's Fun Fest

CHILD INFORMATION:

Child's name

Child's Age/Grade

PARENT/GUARDIAN INFORMATION:

Parent/Guardian Name

This address will receive a confirmation email

Phone

Emergency Contact (if different):

Emergency Phone

Address

MEDICAL INFORMATION:

Allergies:

Medical Conditions:

Medications:

RELEASE & WAIVER:

I give permission for my child to participate in the Valentine's Day Carnival at Word of Faith Family Church. I understand that reasonable precautions will be taken for my child's safety. I release Word of Faith Family Church, its staff, and volunteers from liability for accidents or injuries, except in cases of gross negligence.

In case of medical emergency, I authorize Word of Faith Family Church staff to seek medical treatment for my child.
If you agree please write you name below.

Parent/Guardian Name

PHOTO/VIDEO RELEASE:

I give permission for photos/videos of my child to be used for church marketing and social media.

Yes No

PICKUP AUTHORIZATION:

My child may be released to (in addition to parent/guardian):

Name

Relationship

Parent/Guardian Signature and Date

Parent/Guardian Signature:

Date:

Description

February 14th 1-3pm

Please fill out this form and click submit.

Kids Valentine's Fun Fest

Description

Please Fix the Following