Here is some information about upcoming events at Pinery Baptist Church.
Please plan to stay after the morning service for a special lunch on the 2nd Sunday of each month
Upcoming dates in 2018:
Age:_____ Grade Completed: ______
Allergies: ____ Yes _____ No (If yes, please describe)
Medicine(s): ____ Yes _____ No (If yes, please describe)
Special Needs: _____ Yes _____ No (If yes, please describe)_________________________________________________________
Names (please print): _____________________________________________ Email__________________________________
Address: (Street, City, Postal Code)
EMERGENCY CONTACT (if different from above):
Name _________________________________________ Relationship: _________________ Phone # __________________
Other Instructions, such as custody/pick up permission:
I consent to have pictures of my child taken and used by Pinery Baptist Church Yes___No ___
Our program is possible through the efforts of volunteers. Your child will be cared for as if he/she were our own child. It is understood that caution will be taken by those persons in charge of a particular program to prevent injury, but complete freedom from injury cannot be guaranteed. An incident report will be provided should an accident occur. I hereby consent to let volunteers seek medical attention for my child if I cannot be reached and immediate attention is deemed necessary. I hereby consent for my child to participate in this organized activity. I understand that my child will be under the supervision of a designated church volunteer at all times on the stated dates and times. As a parent or legal guardian, I remain fully responsible for the actions and conduct of my child including any legal responsibility, which may result. In consideration of my child being allowed to participate in this event, I agree to indemnify and hold harmless Pinery Baptist Church, Northville, ON, and its representatives, including volunteers, from any and all claims, including negligence, arising from or relating to my child’s participation in this event. This indemnification and hold-harmless agreement does not apply to claims for intentional misconduct or gross negligence.
Parent/Guardian Name (Please Print) _______________________________________________
Parent/Guardian Signature: ________________________________________________ Date_____________________