NOTE: Additional children in the family with IDENTICAL contact and emergency information may be listed on a separate "ADDITIONAL FAMILY MEMBERS" form.
The following individuals are authorized to pickup my child(ren) from SHBC ministries or events.
I understand and agree that all persons picking up a child who is not the parent must provide a photo ID before a child is released. If another person who is NOT listed above is to pick up your child, you will let us know in writing when checking in your child. I also understand that without a parent tag, it will be necessary to present an ID before a child is released.
OUTDOOR PERMISSION: I am aware that weather permitting, children will be taken outside for playtime. Please dress your child(ren) accordingly (jackets, tennis shoes, sunscreen). My child(ren) have permission to be taken outside, weather permitting, for playtime on the playground and grassy areas.
PHOTOGRAPHY/VIDEO: I am aware that my child(ren) may be photographed/video taped and any photos/videos taken may be used in SHBC publications or on social media/websites.
I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.
In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.
AUTHORIZATION TO CONSENT TO MEDICAL TREATMENT:The undersigned consents: 1. The administration of any treatment deemed necessary by:
OR in the event the appropriate specified practitioner is not available, by another licenced physician or dentists: 2. The transfer of minor to preferred hospital or any hospital reasonably accessible.
3. This authorization does not cover major surgery unless the medical opinions of two other licensed physicans or dentists concurring in the necessity for such surgery are obtained in writing prior to the performance of such surgery.
If you have NO Additional Children to register for 2018-2019 school year click "Submit" now. If you would like to register other student please click "Next"