NEW LIFE KIDS Registration Form-2024 • New Life Family Worship Center

(Please note 3-year-olds must be potty trained before being able to participate in New Life Kids). If you have any questions, please don't hesitate to call 520.586.2337 or email us at admin@newlifebenson.com.

Child Information

First Name *

Last Name *

Gender *

Date of Birth *

School Grade-Current *

Home Address *

Home Address Line 2

Home City *

Home State *

Home Zip Code *

Parent Information

Father/Guardian Name *

Father/Guardian Mobile Phone Number *

Father's Email Address

Mother/Guardian Name *

Mother/Guardian Mobile Phone Number *

Mother's Email Address

Medical Information

Medical Condition *

EMERGENCY CONTACT(s) - Please list at least one emergency contact in the event that you cannot be reached.

Emergency Contact/ Authorized Pick-up Person *

Emergency Contact/Authorized Pick-up (additional)

Emergency Contact Phone Number *

Emergency Contact Phone Number

Permissions

We take pictures during church activities and would like your permission to use these pictures in presentations to our church membership, church website, and our church's social media. We will not reference your child by name or provide specific information regarding your child. The pictures will only be used by NLFWC (New Life Family Worship Center) to show the many ways our children and youth participate in church.

Photo Permission *

Yes, I grant my permission to use photos of my child on NLFWC PowerPoint presentations, website, and social media.

No, please do NOT take or use my child's photo.

This consent form gives permission to seek whatever medical attention is deemed necessary and releases New Life Family Worship Center and its staff of any liability against personal losses of the named child.

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/ her to attend events being organized by New Life Family Worship Center. I/We understand that there are inherent risks involved in any ministry or athletic event and I/we hereby release New Life Family Worship Center, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our childs involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by New Life Family Worship Center, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. I/We also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the ministry staff member/lead volunteer.

By typing your full name here you consent that you are the legal guardian of this child and have thoroughly read the information above including the liability waiver.

***Please also note that for security purposes parents will be given a pick-up receipt when their child is checked in.

Parent/ Guardian Signature *

Date *