Registration Rise City Kids Ministry Registration form. Please Complete this form if you intend to utilize RCC Kids Ministry for your 6 Month Old - 5th grader. Parent / Guardian Information * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Rise City Partner (Member) * Yes No Interested In Joining Child(ren) Attending RCC Kids Information Child 1 * First Name Last Name Birthdate * MM DD YYYY Grade In School * Pre School 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Special Instructions: Allergies, Medical, Behavioral, Learning? Child 2 First Name Last Name Birthdate MM DD YYYY Grade In School Pre School 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Special Instructions: Allergies, Medical, Behavioral, Learning? Child 3 First Name Last Name Birthdate MM DD YYYY Grade In School Pre School 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Special Instructions: Allergies, Medical, Behavioral, Learning? Child 4 First Name Last Name Birthdate MM DD YYYY Grade In School Pre School 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Special Instructions: Allergies, Medical, Behavioral, Learning? Child 5 First Name Last Name Birthdate MM DD YYYY Grade In School Pre School 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Special Instructions: Allergies, Medical, Behavioral, Learning? Persons Authorized for Pick-up Name First Name Last Name Relationship to Child Name First Name Last Name Relationship to Child Name First Name Last Name Relationship to Child Wavier of Liability & Medical Release Form I agree to allow my child(ren) to participate in the children’s ministry of Rise City Church Pensacola. I understand that the necessary precautions and plans for the care and supervision of my child(ren) will be taken during service. Beyond this, I will not hold responsible Rise City Church Pensacola, the staff or volunteers. In case of emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give RCC Kids leadership, staff, or other emergency medical personnel the permission to act on my behalf in seeking emergency medical treatment for my child(ren) in the event that such treatment is deemed necessary by the volunteer, leadership or church staff. I give permission to those administering emergency medical treatment to do so using those measures deemed necessary. I absolve Rise City Church Pensacola, and/or church personnel and volunteers from liability in acting on my behalf in this regard so long as they are not grossly negligent. I, as a parent or guardian of a child participating in Children’s Ministry programs at Rise City Church Pensacola, accept the responsibility for all expenses arising from medical care for injuries to my child(ren) while participating in these activities. Photo, Video Audio Release I understand that pictures and videos may be taken of my child(ren) while participating at Rise City Church Pensacola Kids Ministry. I grant my permission for my child(ren)’s images to be used for promoting or sharing activities from the children’s ministry or church related events, in print materials and/or electronically on the internet. With my signature below I agree to the conditions and terms outlined in the registration form of Rise City Church Pensacola. I understand that this agreement will be effective for one calendar year from the date of my signature. I understand and agree that it is my responsibility to inform and update Rise City Church Pensacola Kids Ministry of any changes concerning my contact information or special concerns involving my child(ren). Thank you for registering with Rise City Church Pensacola Kids Ministry. We look forward to teaching your child(ren) God’s Word on their level.
