Kids Life Registration 2018-2019

Register your child by filling out this form.

NOTE: Fill out one form PER CHILD.

Please note: Admission of this form by email constitutes permission for your child to participate and authorizes Calvary Church to use photos/videos which may include your child(ren) in publications, videos and/or online. All use of photos and videos will be for appropriate and God-honoring purposes.

Your contact info:

Please enter your full address:

Emergency Contact Info:


Medical Release: If my child should become ill or injured at Calvary Church, I understand that a church representative will attempt to contact me or my stated emergency contacts as soon as practical. Should the facility be unable to reach me or the emergency contact person, I authorize the church leader(s) to take one or more of the following steps as they deem necessary: 1)render first aid including administering an epi-pen (if supplied); 2) call 911 for medical assistance; 3) permit medical or surgical diagnosis and treatment as deemed appropriate by a recognized health care professional.

Furthermore, I agree to hold harmless Calvary Church and it's representatives, staff and board members and/or agents free and harmless from any and all claims, demands, law suits, fees, court costs and other sums for damages arising from the giving of such consent and from any action of my child against any person.

I also agree that I will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider and I affirm the health insurance information provided on this sheet is accurate and will remain in force for the minor named above.

My digital signature will be binding as my actual signature. By typing my name in below I agree to all the terms and conditions above and give my full permission for my child to participate in all Kids Life activities.

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