Living Light Kidz VBS

Students Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name

Parent/Guardian Phone Number

Please enter a valid phone number in case of emergency.Format: (000) 000-0000.

Date of Birth

Date

Age

Is Living Light your home church?

Does your child have any allergies?

Are you dropping your child off or staying on campus? If you are dropping off your child you need to be back on campus by 8pm for pick up.

BY SIGNING THIS FORM, I AGREE TO ALLOW MY CHILD TO BE PHOTOGRAPHED. PICTURES ARE ALLOWED TO BE PUBLISHED ON OUR CHURCH SOCIAL MEDIA PLATFORMS AND WEBSITES.

On behalf of all children and adults in our care participating in activities at involving the inflatable bounce houses, I acknowledge and agree to the terms and conditions of this waiver as identified below: There are risks, both known and unknown, using any inflatable or amusement device, including, but not limited to physical injury, emotional injury, distress, paralysis and even death. The risk of serious injury from participating in inflatable bounce house activities, although minimal, does exist, as it does in all play and amusement activities. If the inflatable bounce house is being used outdoors, We take responsibility to make sure the bounce house is setup correctly. If there are wind gusts up to 10 MPH, we will remove all individuals from the inflatable bounce house and deflate it to insure safety of all participants. Should any children be dropped off in our care for use of the inflatable bounce house, I will inform them to follow all rules of participation and will trust their judgment or the judgment or my representative in their safe participation. I understand Living Light COG does not provide a sitting service and is not responsible in their safe participation. I, on behalf of myself, my children, my family members, children in my care, my heirs and my guests, knowingly and freely assume all risks of injury and agree to hold harmless Living Light COG, its staff and volunteers with respect to any claims, demands, causes or rights of action, even if arising from the actions, acts of omission or negligence of said entities or individuals.