Which activity are you signing your student up for?
Afters - Sep 21 (HS Only)
Trivia & Wings - Oct 26 (HS Only)
Great Pumpkin Hunt - Oct 29 (HS & JH)
AFTERS | 7-9PM | $4
We will be leaving the church as soon as everyone arrives. Please provide $4 for your student to turn in when they arrive. If there is an issue with the money, please contact Pastor Jesse, we never want money to stand in the way of what we're doing.
TRIVIA & WINGS | 7-9PM | $5
We will be leaving the church as soon as everyone arrives. Please provide $5 for your student to turn in when they arrive. If there is an issue with the money, please contact Pastor Jesse. We never want money to stand in the way of what we're doing.
GREAT PUMPKIN HUNT | 6-10PM | $10
We will be gathering at the church for snacks, pictures and a costume contest. Afterwards, we will split into teams and leave the church (with approved drivers) to a specific location and begin our hunt for the 'Great Pumpkin,' using the clues he left behind. For any questions, please contact pastor Jesse.
The grade they will enter in the fall
Parent/Legal Guardian Information
If we end up with more students than usual, would you be available to help drive students to and from our destination?
THANK YOU SO MUCH!!
Jesse will contact you at the phone number provided if he needs the extra seats.
Have you already filled out a permission slip for the 2021/22 School Year?
The new school year means new Permission slips, but unless the information changes, this will last you until the summer.
Note: if this is the first time you're filling out this form for this school year, the answer must be "No."
Please read the following information and click the box next to each statement acknowledging you've read it and agree with it.
Parent/Guardian acknowledgment of the following statements:
Checking this circle acknowledges that my child has permission to participate in Long Beach Alliance Church’s Beach Day. To the best of my knowledge, my child is healthy and fit for an active program. I acknowledge that there may be inherent possibility of risk (including but not limited to: minor bumps and bruises, choking, shark attacks, injuries from vehicle accidents, etc.), and agree to hold harmless Long Beach Alliance Church, its employees and volunteers for any loss, damage, injury, disease or death which results from this activity. In case I cannot be reached in an emergency, I hereby give my permission to the licensed health care provider selected by Long Beach Alliance Church to secure medical treatment including hospitalization, injections, anesthesia or surgery as may be deemed necessary for the child listed above. I also understand and agree that I am responsible for all expenses incurred in the event of an emergency.
I understand the Long Beach Alliance Church staff, volunteers, and leaders will make every attempt to contact me as soon as possible in the event an emergency arises. If contact cannot be made, I authorize the Long Beach Alliance Church staff, activity volunteers, and leaders to provide medical care, and if necessary, take my child to a doctor or medical facility. I also authorize medical treatment recommended by medical staff and I assume responsibility for all medical costs.
I, on behalf of my child, myself, my children, my assigns, and my estate, assume the risk and promise to release from liability and hold harmless for personal injury or sickness and/or damage to personal or public property resulting from my child’s participation, Long Beach Alliance Church, its officers, Governing Board, Elders, agents, employees, and/or volunteers for any and all claims for injuries, causes of action, or liability related to my and/or my minor child’s participation in the above Long Beach Alliance Church youth onsite or offsite activity. This release does not apply to intentional and/or willful acts of misconduct by Long Beach Alliance Church or any of its officers, Governing Board, Elders, agents, employees, and/or volunteers.
I agree to indemnify and hold harmless the Long Beach Alliance Church, its officers, Governing Board, Elders, agents, employees, and/or volunteers for any liability incurred or property damage/loss sustained by Long Beach Alliance Church as the result of the negligent, willful, or intentional conduct of my child, including expenses attendant thereto.
I hereby certify that I have read and clearly understand these terms and that this authorization/waiver/covenant is being executed voluntarily.
Is there anything special that you would like Pastor Jesse to know?
If your student is coming as the friend of another student, please type their name in this space.
By typing your name in the space below, you are affirming the accuracy of this form.
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