Children's Waiver Form

您的瀏覽器尚未啟用 JavaScript，因此無法開啟檔案。請於啟用後重新載入頁面。

Parents please fill out one waiver per child.

登入 Google 即可儲存進度。瞭解詳情

電子郵件 *

Parent Name *

Parent Phone *

Child's Name *

Child's Grade

Child's Birthdate *

YYYY

Does your child have any dietary needs or restrictions?
*

I, the parent/guardian of the above-named participant, release Living Springs Church, directors, staff, and leadership team from any loss, personal injury, accident, misfortune, or damage to the above named or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above-named student. Saskatchewan Health Care or equivalent medical insurance must cover each child.
*

Yes

I agree to permit the reasonable use of photos and videos or other such pictures of the applicant child in promoting Living Springs Church, LSC Youth Ministries activities and programs.
*

Yes

Please list any other comments or questions.

Signature: By entering my name in the following lines, I understand this will act as my legal signature and consent in agreement with the above waiver questions.
*

Date Signed *

YYYY

系統會透過電子郵件將你的作答內容複本傳送到你所提供的地址。

提交

清除表單

請勿利用 Google 表單送出密碼。

reCAPTCHA

隱私權條款

Google 並未認可或建立這項內容。檢舉濫用情形 - 服務條款 - 隱私權政策

表單