Kids Consent Form

ONE PER CHILD

I hereby give my consent for my child to
participate in Northside Baptist Church (NBC) activities, church sponsored trips, (including, but not limited to, travel to
and from said activities) and in other activities that are part of the expanded Northside program. It is my clear understand-
ing that participation in activities creates a risk normally associated with such activities, including the potential for cata-
strophic injury or even death. I understand the possible risks that may be involved in these activities, and do not hold
Northside Baptist Church, it's staff, or volunteer workers liable, and that, by signing this form, I am stating that I will not
hold NBC, it's staff, or volunteer workers at fault in case of sickness or the accidental injury (including death) of my child.
In the event of sickness or some other medical emergency, I request that my child receive any medical attention or
treatment deemed necessary; therefore, I give permission to any hospital, doctor, and/or health care provider to
transport, treat and/or admit for care, my child.

I hereby give permission to Northside Baptist Church to use my child's image, whether by video, photography or other wise in Church website, publications, or publicity.
Yes
No

Child's First Name

Child's Last Name

Child's Gender

Child's age

Date of birth

School Attending

Grade in 2021-22

Address 1

Address 2

Country

City

State

Zip/Postal Code

ALLERGIES OR OTHER MEDICAL CONDITIONS

1st Parent/Guardian

2nd Parent/Guardian

Home Telephone

1st Guardian's Phone Number

1st Guardian's Email Address

2nd Guardian's Phone Number

2nd Guardian's Email Address

Home Church

Insurance Company

Policy Number

EMERGENCY CONTACT

EMERGENCY PHONE NUMBER

RELATIONSHIP TO CHILD

By typing your full name and today's date in the box below and submitting this form you are agreeing to indemnify, release and hold Northside Baptist Church harmless from any and all liability in providing care and treatment to my child, and further, I grant my permission regarding use of the above information.

Email Address

SUBMIT

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Sunday-Night-Lights-Registration-Form-63.pdf

Kids Consent Form

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Service Times

Sunday Mornings

Sunday Evenings