Authorization for Student Pickup: Picture ID is REQUIRED for Drop Off and Pick Up.
When your child arrives, it is your responsibility to escort your child and sign in your child. You will also be required to sign your child out at the end of the day. Your child will not be released to anyone who does not have written authorization and photo ID in your child’s file.

Up to 3 names and phone number(s) of person(s) other than parents allowed to pick up your child: (ID's will be necessary at pick up).

Any special instructions, such as custody or restraining orders must be discussed personally with staff. All information will be kept confidential.

Summer Fun Days Attitude Agreement

"Summer Fun Days" is a Christian event put on by the members of Lighthouse Baptist Church. We will be teaching, talking about, and demonstrating the love of our Lord Jesus Christ. You do not have to be a Christian to attend this activity, but understand that there will be prayer, singing, and Biblical studies.

By submitting this application form, you are agreeing that you have been notified to the direction and the spiritual content that this activity will have.

Informed Consent and Acknowledgement

I hereby give my approval for my child's/childrens participation in any and all activities on July 13, 20, and 27 prepared by Lighthouse Baptist Church during the "Summer Fun Days".  I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Lighthouse Baptist Church . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected activities.

In case of injury to said child, I hereby waive all claims against  Lighthouse Baptist Church. including all volunteers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all physical activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the  Lighthouse Baptist Church . and its affiliates including Directors, Staff, and Staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.