Graffiti Girls Registration

Student Name *
Student Name
Street Address
Street Address
Guardian Phone Number (cell/work)
Guardian Phone Number (cell/work)
Guardian's Address 1
Guardian's Address 1
Student's Birthdate
Student's Birthdate
Section

As legal guardian of the student listed above I hereby give permission for he/she to participate in activities organized by Calvary Baptist Church.

 

Covering: ALL GRAFFITI GIRLS ACTIVITIES ORGANIZED BY CALVARY BAPTIST CHURCH, ITS STAFF, TEACHERS, OR OTHERS UNDER THE DIRECTION OF CALVARY AUGUST 22-23, 2014

 

                I understand that, in the event that (minor’s name) requires medical or dental treatment while engaged in the activity, reasonable efforts will be made to contact me; however, if I cannot be reached, I hereby consent and give my permission to the ministry’s sponsor or any adult counselor acting on behalf of the ministry with respect to the Activity, as agent for me, to consent to any X-ray examination, injections, anesthesia, medical, dental, or surgical diagnosis and treatment; and hospital care and treatment advised and supervised by a physician, surgeon, or dentist licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital.

                I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed.  I understand all reasonable safety precautions will be taken at all times by Calvary Baptist and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk during the activities.  I also agree not to hold Calvary Baptist, its leaders, employees, volunteer staff, and agents liable for damages, losses, diseases, or injuries incurred during my student’s participation in the activities and events.

                I also understand that visual and audio recordings may be made of these activities, and can be used by Calvary Baptist as needed for publicity, announcements, scrapbooks, etc.

Date
Date