PARENT'S NIGHT OUT - April 26, 2024
Consent and Liability Waiver

Please fill out the following form in order to participate in our activity.

Child's First, Last Name and Age

For additional children - Child's First, Last Name and Age

Parent's First and Last Name and Cell Phone Number:

Parent's Email Address

I agree to be placed on an email mailing list for future KIDS CHURCH events…

Yes

Does the child(ren) have any known allergies or medical conditions we need to be aware of?

Yes

Unknown

If you answered yes to the above question, please explain:

CONSENT & LIABILITY WAIVER

On this 26th day of APRIL, 2024, intending to be legally bound here, I (the undersigned), agree hereby release from all liability and to indemnify and hold harmless Connections Kids Church Ministry, as well as Connections Community Church, and any of their volunteers. This release waiver is for any and all liability upon my child(ren) (listed above) and/or their personal property. Furthermore, I give my permission for my child(ren) to participate in the Parents Night Out event, on April 26, 2024 from 6-9pm. I agree to pick this up no later than 9:15pm on the same night of the event.

I declare that the info I’ve provided is accurate & complete

Your Inituals will act as your signature. By Initialing below you give consent to allow your child(ren) to participate,as well as release us from all liabilities:

Please Print Your Name

Date

Thanks for submitting!

Sunday Morning's at 10am
MidWEEK Service - Wed. at 6pm

3491 Broadway Ave
North Bend, Oregon, 97459

LOVE GOD • LOVE OTHERS

PARENT'S NIGHT OUT - April 26, 2024
Consent and Liability Waiver

PARENT'S NIGHT OUT - April 26, 2024 Consent and Liability Waiver

PARENT'S NIGHT OUT - April 26, 2024
Consent and Liability Waiver