The WEB Spider Lake Church After School Program K-5th Grade '25-'26

Name of Child 1

First NameLast Name

Name child prefers to be called

Birth Date

Grade

3rd4th5thOther

Gender

MaleFemaleN/A

Allergies/Aversions: please specify

Other information leaders should know about the child

Name of Child 2

First NameLast Name

Name child prefers to be called

Birth Date

Grade

3rd4th5thOther

Gender

MaleFemaleN/A

Allergies/Aversions: please specify

Other information leaders should know about the child

Name of Child 3

First NameLast Name

Name child prefers to be called

Birth Date

Grade

3rd4th5thOther

Gender

MaleFemaleN/A

Allergies/Aversions: please specify

Other information leaders should know about the child

Will your children be walking from the Intermediate/Primary School with us to the Spider Lake Church Main St. Campus?*

Yes, he/she/they will be walking with the group to the church.No, I will provide transportation.

If you are allowing your child/children to walk from the intermediate school with us, you will need to contact the school to give permission prior to the first day of participation.

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian 1

First NameLast Name

Best phone number to reach you

Email

example@example.com

Parent/Guardian 2

First NameLast Name

Best phone number to reach you

Area CodePhone Number

Email

example@example.com

Others that may pick up my child/children

Emergency Contact 1

First NameLast Name

Relation to child/children

Phone Number

Please enter a valid phone number.

Emergency Contact 2

First NameLast Name

Relation to child/children

Phone Number

Please enter a valid phone number.

Authorization for Media Release*

Spider Lake Church may post a photograph and/or video of my child on the church's website or use a photograph of my child/children in their publications, media, and/or on the screen at church. I understand that photos will not be labeled with names.I ask that Spider Lake Church not post photographs and/or videos of my child on the church's website or use a photograph of my child in their publications.

Functions and Activities

It is my understanding that participating in the programs and recreational and other activities of SPIDER LAKE CHURCH is a privilige. Prior to my participation in such activities, I acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.

Release of Liability

By printing your name and dating this Permission/Waiver Form I expressly warrant that the child/children named above is capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the child/children participating in the activities, whether such risks are known or unknown to me at this time. I further release SPIDER LAKE CHURCH and its ministers, leaders, employees, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall exlude any gross claims of negligence. This release of liability is also intended to cover all claims that members of the child's/children's family or estate, heirs, representatives, or assigns may have against SPIDER LAKE CHURCH or its minsiters, leaders, employees, volunteers, or agents.

I further agree to indemnify and hold harmless SPIDER LAKE CHURCH and its ministers, leaders, employees, volunteers, or agents from any and all claims arising from my participationin in its activities and programs, or as a result of injury or illness of my child/children during such activities.

First Aid and Emergency Medical Treatment

I recognize that there may be occasions where the child/children named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of SPIDER LAKE CHURCH to seek and secure any needed medical attention or treatment for the child/children named above, including hospitalization, if in the agent's opinion such need arises. In doing so i agree to pay all fees and costs arising from this action to obtain medical treatment.

Special Events and Field Trips

I understand that the child named above may be participating in local service projects and fellowship events during church children events. I understand that during this period my child/children may take part in activities such as: multi-church children gatherings, community building events, minor yard work, cleaning, painting, and other activities consistant with the purpose of the church.

Information Notes

All drivers during children's ministry-related events must be 21 years of age with a good driving record. All drivers of the church van must be 25 years of age and must meet the stringent requirements of our insurance company, including a Department of Motor Vehicles background check. While we understand that older youth may drive themselves to and from events, we will not give any child permission to ride home with any other youth; this must come from the parents themselves.

Health Insurance Information

Insurance Company

Primary Insurance Card Holder

Policy NumberInsurance Company Phone Number

Medical DoctorPhone Number

Medical History (Special medical needs or concerns including medications, etc)

Special medical needs or concerns

I represent that I am the parent/guardian of blanks , who is/are under 18 years of age. I have read the above Permission/Waiver Form and am fully familiar with the contents thereof.

I give permission for the child/children named above to participate in the activities of SPIDER LAKE CHURCH, including any special events/activities described above. In consideration for allowing the participation of the child/children in the activities of SPIDER LAKE CHURCH, I hereby consent to the Permission/Waiver Form, including the Release of Liability above, on behalf of the child/children, and agree that this Permission/Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns. I further agree that typing my name and date below will hold the same legal consent as a written signature.

Consent Typed Signature*

First NameLast Name

Date*

Date

The WEB

Spider Lake Church Main St Campus