Parent/Guardian Name *

First Name

Last Name

Phone *

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By registering my child(ren) for KIDtern Week at University Avenue Baptist Church (UABC), I, on behalf of myself and/or the minors I have registered, do hereby release, forever discharge and agree to hold harmless UABC, its pastor staff, leadership, employees, and volunteers from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by myself or those I have registered while participating in KIDtern Week at UABC. I and the minor(s) I am registering assume all risk of personal injury, sickness, death, damage and expense as a result of participation KIDtern Week at UABC.

I Do

I agree that in the event of an accident, illness, injury, or any other unforeseen emergency, I will not hold University Avenue Baptist Church (UABC), church employees, or volunteers personally responsible or bring any legal actions against them. I understand that every effort will be made to contact me in case of emergency. If UABCis unable to reach me, I give my authorization and permission to the UABC team to obtain necessary medical attention in case of sickness or injury to my child. I, the undersigned, do hereby verify that the above contact information is correct and I do hereby release and forever discharge UABC, its pastoral staff, leadership, employees, and volunteers from any and all claims, demands, actions or causes of action, past, present, or future arising out of any damage or injury while participating in KIDtern Week.

I Do

I give my consent for UABC to use my child's photographs and video footage in church promotion, publicity, and website.

I Do

I Do Not