2025 International Thanksgiving Blending Conference Childcare Registration

2025 International Thanksgiving Blending Conference

Indianapolis, IN

Registration & Medical Release Form for Childcare

Child Information

Child's First Name*

Child's Last Name*

Locality:*

Grade (Current or Most Recent):*

Gender:*

MaleFemale

Birth Date*

DayMonthYear

Age:*

As of Conference Dates

*Children in Grade K must be currently enrolled*

*Children must be at least 5 years old at the time of the conference.

Attendance

Which meetings will your child be in Childcare? (Check all that apply)*

Allergies (Food/Medical) & Special Needs

Allergies (Food/Medical) & Special Needs*

(Special needs would include asthma, diabetes, seizure, autism spectrum, etc.)

Parent/Guardian Information

Parent or Legal Guardian:*

Relationship to Child:*

Mobile Telephone:*

E-mail:*

example@example.com

I acknowledge that my child must be at least 5 years old and in Kindergarten in order to participate in Childcare.

Authorizations

Alternate Responsible Persons: An "Alternate Responsible Person" is an adult, 18 years of age or older, who will be present at the conference venue for the meeting session(s) in which your child will be in Childcare.

In the event of an emergency or illness with my child, I authorize LSM Childcare to contact the following alternate responsible persons, if I cannot be reached. I also authorize these persons to pick up my child from Childcare.

Alternate Responsible Person (1)*

Relationship to Child:*

Mobile Telephone:*

Alternate Responsible Person (2)*

Relationship to Child:*

Mobile Telephone:*

Medical Release and Release of Liability

Emergency Medical Services: I also authorize LSM Childcare to call an emergency ambulance in the event that my child suffers an accident or becomes acutley ill, and to arrange for necessary emergency medical or surgical care if I am not immediately available. It is understood that a conscientious effort will be made to notify either myself or the persons designated above, before such action will be taken.

Liability Release: I agree to hold harmless and indemnify Living Stream Ministry, the local church in which I am a member, and any of the other affiliated local churches or church affiliated organizations, members, serving ones, responsible adults, or volunteers present at the event referenced above, from any and all injuries, claims, damages, liability, costs and expenses including, but not limited to, attorneys' fees, litigation expenses, court costs, and all other sums which the persons and organizations referenced above may pay or become obligated to pay on account of any, all and every demand for claim or assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of the 2025 International Thanksgiving Blending Conference.

Conduct: Children must listen to and follow the instructions of the Childcare serving ones at all times. Physical altercation, verbal abuse, damage of property, possession of inappropriate items or substances, or persistent disobedience will not be tolerated and is cause for immediate dismissal from Childcare. Childcare reserves the right to remove any child from Childcare at any time.

Personal Items: Children are not allowed to bring toys, electronics, food, or any other personal items into LSM Childcare.

Signature of Parent or Guardian:*