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

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.
YesNo
Submission Date

MonthDayYear
Date
Parent/Guardian Signature
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