Beacon Kids Club 2022-2023

Beacon Kids Club Registration

Kids Club begins on Wednesday, September 14th - Please register below:
Child Information
Child Name *

First Name Last Name
Age *
Birth Date *

Month Day Year
Current Grade *
T-shirt Size *
Allergies/Medical Information
Parent/Guardian Information
Parent Name *

First Name Last Name
Email *
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Emergency Contact

First Name Last Name
Emergency Number

Area Code Phone Number
RELEASE/DISCLAIMER
MEDICAL/INJURY RELEASE

I hereby give permission for my child to participate in the Beacon Kids Club Program. I understand that Beacon Baptist Church is a nonprofit/Church which is voluntarily presenting this program for my child, other participants, and the community. I also understand that the program has activities that can involve physical contact with other participants, the ground or equipment, sports activities, games, bounce houses, etc. and that there is a resulting risk of physical injury to my child.

In Consideration of my child’s participation in Beacon Kids Club and the use of the Beacon Baptist Church facilities for Beacon Kids Club, I hereby release and covenant not to sue the Church, its members, trustees, directors, officers, employees, representatives, volunteers, agents, and lessees from any and all present claims resulting from ordinary negligence and inherent risk of use of the facilities and equipment of Beacon Baptist Church including, but not limited to, any loss, injury, damage or liability sustained by my child while on or about the premises of Beacon Baptist Church. I also give permission for the staff, representative, or volunteers of Beacon Baptist Church to administer first aid or to seek medical care for my child during my child's participation in the program, including transportation of my child to a medical facility for additional treatment that appears necessary.
*

I Agree to the Medical/Injury Release.
Parent/Guardian Signature *

First Name Last Name
PHOTO/VIDEO RELEASE

I understand that photographs or videos of my child (this registrant) may be used in publications of Beacon Baptist Church (including the church website and social media pages.) I understand that these photos/videos may be viewed by anyone but no identifying information will be displayed.
*

I Understand and Agree to the Photo/Video Release.
Parent/Guardian Signature *

First Name Last Name
ALLERGY RELEASE

Beacon Baptist Church cannot guarantee that all snacks, foods, candies, etc. are allergen free. Products may contain wheat, egg, dairy, soy, nuts, peanuts, etc. that could cause an allergic reaction to your child.
*

I Understand and Agree to the Allergy Release.
Parent/Guardian Signature *

First Name Last Name
Should be Empty:

Beacon Kids Club Registration

RELEASE/DISCLAIMER