Living Waters Academy Enrollment Form

Enrollment Form

Please use this form to submit your application for enrollment with Living Waters Academy
Parent's Name

Authorized person/s to pickup your child after the Vacation Bible Study
Parent/Authorized Adult Name*

First NameLast Name
Parent's Email Address
example@example.com
Parent's Phone Number*
Please enter a valid phone number.
Additional Parent/Authorized Adult Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Children's Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Children

(Being Enrolled)
Your Children*
Do any of your children have a medical condition that we should be aware of?*

YesNo
Medical Conditions
Any Additional Information you would like to provide:

Emergency Contact Information
Emergency Contact

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Reminders
- I allow my child to participate in this program.
- We can provide a refund if you cancel your registration 5 days prior to the start of the program. If it is below 5 days, then the fees are non-refundable.
- I hereby authorize the school, the Principal, volunteer personnel to conduct first aid, and medical care in the event of an emergency situation. I agreed to pay for all the medical care expenses and costs in a given situation that medical care is needed. (For in-person)
- I release the organizers from any liabilities that might happen during the activity and hold them harmless in the event of damages, injuries, or accidents.
- I confirm that all information in this form is accurate and true to the best of my knowledge.
Would it be okay if we take photos and videos of the participant during the activity which will be posted on the Academy website or on social media*?*

YesNo
Submission Date

MonthDayYear
Date
Parent/Guardian Signature

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Date Signed

MonthDayYear
Date
* We do not use Facebook, Twitter, Instagram, SnapChat or TikTok and if you do request any specific image of your child being used we will remove without question.
Should be Empty:

Enrollment Form