Kid's Christmas Event at Lighthouse

Kid's Christmas Event

Lighthouse Niagara
Saturday, November 28th - 10:00 am to 12 noon

Ages 5 - 12
Child's Name

First NameLast Name
Age (now)
Child's Name

First NameLast Name
Age (now)
Child's Name

First NameLast Name
Age (now)
Child's Name

First NameLast Name
Age (now)
Parent/Guardian Information
Parent / Guardian's Name

First NameLast Name
Relationship to Child(ren)
Phone Number
Format: (000) 000-0000.
E-mail
Home Church (if any)
Emergency Information
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Relationship to child(ren)
Food Allergies or other Medical Conditions (name each child & their condition)
Medical Waiver
All reasonable precautions for the safety and health of the participants will be taken. He/She/They will be properly supervised in activities.

In the event of accidents or sickness, Lighthouse Church of God, its staff and volunteers are released from any liability. In the event of injury requiring medical attention, I authorize treatment for the participant and understand that reasonable attempts will be made to contact the listed emergency contact above, should such a situation occur.

The participant must be covered by provincial health insurance or equivalent medical coverage.
Dismissal

Please pick up your child promptly at 12 noon.
My child(ren) has permission to walk home by themself
Name of adult who will be picking up my child(ren)

First NameLast Name
Photos/Video
Photos/videos are taken for promotional purposes related to Lighthouse Niagara and its Children's Ministry. These pictures appear within the church only (NOT on social media).
Do you allow your child to be included in these photos/videos?
Other Information
Comments and/or Questions
I waive any responsibility to all staff and volunteers for any lost or damaged items that my child(ren) may bring with them.
Today's Date

MonthDayYear
Parent/Guardian Signature

First NameLast Name
Should be Empty:

Kid's Christmas Event

Saturday, November 28th - 10:00 am to 12 noon

Parent/Guardian Information

Emergency Information

Medical Waiver

Dismissal

Photos/Video

Other Information