Registration and Waiver

Parent/Guardian Completeing Form

First and Last

Parent Email

Phone Number

Address

Child #1 Name and Date of Birth

Child #2 Name and Date of Birth

Child #3 Name and Date of Birth

Child #4 Name and Date of Birth

Child #5 Name and Date of Birth

In case of emergency, I hereby give permission to the licensed physician and or hospital selected by Living Word Christian Academy/Living Word Church to hospitalize, secure treatment for, and order injection, anesthesia, or surgery.

Yes | I understand that selecting "yes" is giving my consent to the above statement

I am responsible for any medical care needed for myself or my child in case of emergency and or incur any cost upon which my child must return home due to medical or disciplinary reasons. I release Living Word Christian Academy / Living Word Church and its respective agents from any liability for injury or damage and assume all risks relating to my child’s participation in activities.

Yes | I understand that selecting "yes" is giving my consent to the above statement