2023 LH KIDS VBS: Ready, Set, Move! Registration & Activity Waiver Form -North Campus

June 28, 29, & 30, 2023 @ 6:30pm | Are you EXCITED ABOUT READY, SET, MOVE?? Let's get ready to go where Jesus tells us to go! Fill out the form if your child(ren) will be attending Vacation Bible Study! We will be servicing PK- 6th Grade! Each evening we will begin at 6:30pm!! PLEASE BE SURE TO COMPLETE THE ACTIVITY WAIVER FOR EACH CHILD, found in your confirmation email, once Registration is submitted.

Today's Date

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The undersigned parent/legal guardian hereby gives permission to The Lighthouse Church, for my child(dren) to take part in this activity. One waiver per child.

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Parent/Guardian Name

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Email

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This address will receive a confirmation email

Phone

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List All Children that will be attending The KDZ Ready, Set, Move Vacation Bible School Experience that are between PK (potty trained required) through 6th grade! Please complete each field for each child including the activity participation waiver.

Name of Child 1

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Birthday

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Grade

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Please select one option.

PK K 1st 2nd 3rd 4th 5th 6th

T-Shirt Size

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Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Checking this box gives the child listed above permission to participate:

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Please select all that apply.

Yes, my child has permission to participate.

Name of Child 2

Birthday

Grade

Please select one option.

PK K 1st 2nd 3rd 4th 5th 6th

T-Shirt Size

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Checking this box gives the child listed above permission to participate:

*

Please select all that apply.

My child has permission to participate.

Name of Child 3

Birthday

Grade

Please select one option.

PK K 1st 2nd 3rd 4th 5th 6th

T-Shirt Size

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Checking this box gives the child listed above permission to participate:

*

Please select all that apply.

My child has permission to participate.

Name of Child 4

Birthday

Grade

Please select one option.

PK K 1st 2nd 3rd 4th 5th 6th

T-Shirt Size:

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Checking this box gives the child listed above permission to participate:

*

Please select all that apply.

My child has my permission to participate.

Name of Child 5

Birthday

Grade

Please select one option.

PK K 1st 2nd 3rd 4th 5th 6th

T-Shirt Size:

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Checking this box gives the child listed above permission to participate:

*

Please select all that apply.

My child has my permission to participate.

PLEASE READ CAREFULLY, THIS PERMISSION SLIP IS A LEGAL DOCUMENT WHICH INCLUDES A RELEASE OF LIABILITY AND INDEMNIFICATION Should my child(ren) require immediate or emergency medical care while engaged in an activity sponsored by The Lighthouse Church, in my absence, I hereby grant The Lighthouse Church authority to release my child(ren) for medical treatment to such medical personnel as The Lighthouse Church determines appropriate under the circumstances. In consideration for the privilege of allowing my child(ren) to participate in the above-named activity, I agree to release and hold harmless The Lighthouse Church, its officers and agents, from any liability to or responsibility for bodily injury, damage or illness to the above-identified child(ren) while participating in any youth athletic or social activity which may be directly or indirectly sponsored by The Lighthouse Church. Further, I agree to indemnify and hold harmless the Church, its officers and agents with respect to any claim asserted by or on behalf of my child(ren) as a result of bodily injury, illness, or damage. Place your initials here to acknowledge reading of the permission slip.

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Parent/Guardian Initials

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Emergency Contact Name

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Emergency Contact Number

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Insurance Name

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Insurance Member Number

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*By Entering my name in the box below, I am providing my electronic signature and approval on the information provided and released.

Electronic Signature of Parent/Guardian

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If you have any additional questions or concerns, please send them via email to KDZ@lhhouston.church

Payment $0

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 28, 29, & 30, 2023 @ 6:30pm

Are you EXCITED ABOUT READY, SET, MOVE?? Let's get ready to go where Jesus tells us to go! Fill out the form if your child(ren) will be attending Vacation Bible Study! We will be servicing PK- 6th Grade! Each evening we will begin at 6:30pm!! PLEASE BE SURE TO COMPLETE THE ACTIVITY WAIVER FOR EACH CHILD, found in your confirmation email, once Registration is submitted.

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