1st Child:    First Name *     Last Name *     Birthdate *       Male     Female *     Age *         Grade *     Allergies *    

2nd Child:    First Name     Last Name     Birthdate       Male     Female     Age         Grade        Type option 2     Allergies    

3rd Child:    First Name     Last Name     Birthdate       Male     Female     Age         Grade     Allergies    

4th Child:    First Name     Last Name     Birthdate       Male     Female     Age         Grade     Allergies    

5th Child:    First Name     Last Name     Birthdate       Male     Female     Age         Grade     Allergies    

Initials *    Medical & Liability Release: I give permission/consent for my child(ren) to participate in classes and activities at Colton First Assembly and consent and agree to indemnify and hold harmless Colton First Assembly, it's agents, employees, or volunteer assistants from all claims that I or the church might have arising out of my child's participation in this program which is over and above that which is covered by insurance. 

Initials *    Emergency: I authorize the volunteers and staff to administer emergency medical first aid treatment, or to call for emergency medical response as needed. 

Initials *    Publicity: I consent to the use of any audio or visual record of the child(ren) named above to be used, distributed, or displayed as agents of the church see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings for use in the church publications or advertising materials to let others know about our ministry.