CHILD Rider-REGISTRATION FORM

Child/Minor RIDER-REGISTRATION

* Indicates required field

Child/Minor Name *

First

Last

AGE *

Gender *

Male Female

Please List Any Additional Children or Minors *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Liability Release/Consent

I the undersigned parent or guardian, hereby consent to my child(ren) listed below to participate in the programs and activities sponsored by The Visible Church of Green Bay. These activities include but are not limited to Sunday school, Kids Camp, Mobile Church and Shuttle Bus services. (Please read and initial below)

Parent/Guardian Signature *

Personal Belongings Release
I realize that the church or its sponsors are not responsible for personal belongings.

Please Initial *

Photo Release
I authorize and release, the publication, use or reproduction of any and all photographs/video taken of participating minors in church sponsored activities. The use may include but is not limited to social media, print advertisements and church communications.

Please Initial *

Discipline Release (Applies to students/minors only)
In the event of misconduct deemed harmful to self or another or illegal behavior, I authorize the staff/volunteers to send my student home.

Please Initial *

General Release of Liability
The undersigned or a member of the immediate family of the undersigned realizes that the participant may incur personal injury or bodily damage while participating in such activities, and acknowledge that the church, it’s officers, directors, employees, agents, or any other parties volunteering on behalf of the church shall be held harmless from all actions, claims, costs, expenses or damages of any kind, growing out of or related to any activities of the church. I fully acknowledge this is a full and complete release for all injuries and damages which the participant may sustain as a result of participation in any activity

Please Initial *

EMERGENCY CONTACT

(In the unlikely event of an emergency, this is my preferred method for emergency contact.

Primary Contact Name *

First

Last

Alternate Contact Name *

First

Last

Phone Number *

Email (This is optional) *

SAVE YOUR SEAT

Child/Minor RIDER-REGISTRATION

Liability Release/Consent

EMERGENCY CONTACT

Come Visit:

Telephone

Email

Sign up for "THE LOOP"