Kids age 0 - 6th Grade and Parent Info
Parents/Guardian Information
Emergency Contact if parent/guardian is unavailable
Please check all that apply
PARENTAL CONSENT
I hereby authorize and give my consent for my child(ren) to participate in Atonement Lutheran Church sponsored trips and activities on and off the premises of Atonement and to ride in any vehicle provided by Atonement or owned by private individuals. I also understand that if my child(ren) becomes unmanageable or a discipline problem, Atonement may send them home immediately at my expense and I will forfeit my money paid for my child(ren)’s participation in the event.
PHOTOGRAPHY RELEASE
Activities sponsored by Atonement Lutheran Church are often photographed and/or videotaped. As parent or guardian, I give my permission for my child(ren) listed above to be photographed and/or videotaped with the understanding that the photographs/video may be used for such purposes as scrap books, video presentation, Facebook, website, publicity, etc. by Atonement Lutheran Church and its Representatives.
MEDICAL RELEASE
I understand that, if medical treatment is required, every effort will be made to contact me. In the event of an emergency, I hereby authorize Atonement Lutheran Church and its staff, employees, drivers, sponsors, volunteers, and helpers (collectively “Representatives”) to take any steps they deem necessary to obtain emergency medical care including without limitations X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care for my child(ren) and I hereby release Atonement Lutheran Church and its Representatives from any financial liability incurred during such emergency treatment
CHURCH RELEASE
I hereby release Atonement Lutheran Church and its Representatives from any liability for injury or damages suffered by the above child(ren) and agree to release, indemnify and waive any rights by subrogation I may have, and hold harmless Atonement Lutheran Church and its Representatives for claimed or asserted injury or damage to my child(ren).
ACKNOWLEDGMENT
These authorizations and agreements are expressly granted from the date above until expressly revoked in writing by me or one year from this date, whichever comes first.