GC KIDS WAIVER & REGISTRATION • Game Changer Church

Family Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number *

Email Address *

Child Information

Child 1 First Name *

Child 1 Last Name *

Child 1 Grade *

Date of Birth *

Child Allergies

Tip: We provide a juice box and snack, so please let us know of any allergies.

Please Specify:

Release of Liability

By consenting to this Release Form, I expressly warrant that the child/children named here is/are capable of withstanding both the physical and mental demands of the planned activities. I also expressly assume all risks of the child whether such risks are known or unknown to me at this time. I further release Game Changer Church and its ministers, leaders, employees and volunteers from any claim that my child may have against them as a result of an 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 intended to cover all claims that members of the child's or my family or estate, heirs, representatives, or assigns may have against Game Changer Church or its ministers, leaders, employees, or volunteers.

Please state whether or not your consent to the release of liability for your child/children. *

Yes

Media Release

On occasion, Game Changer Church takes photographs or makes audio/visual recording of children involved in church activities. Such photographs and audio/visual recording may be used in Game Changer Church's publications, social media or website. I consent to the use of such audio/visual recording of the child/children named here to be used, distributed, or displayed, as the directors of the church see fit.

Photography Consent *

Yes

Date Signed *