Jammin' with Jesus Registration
We are so glad your child will be joining us! Fill out this quick form and they'll be jammin' in no time!
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Child's Last Name *
Child's First Name *
Child's age *
Allergies/Medical Conditions *
Parent / Guardian Name(s) *
Cell Phone # *
Email *
Name and phone # of person we should contact in case of an emergency during this event. *
This Permission Form is to certify that I, as parent/guardian, consent to my child/children (listed above) attending this event (listed above) at the Pluckemin Presbyterian Church under the jurisdiction of the organizers, sponsors, officers, employees, agents and servants of the Pluckemin Presbyterian Church;  and release the said Pluckemin Presbyterian Church, its successors and assigns, its officers, directors, trustees, employees and agents, volunteers together with the organizers, sponsors, officers and employees and volunteers of the said event including from any and all claims or actions whatsoever based on my child attending said event including but not limited to any and all claims for damages, costs, expenses and injuries.  Checking the box below indicates your agreement to the terms above.       *
Required
In the event of an emergency where medical treatment is required, I give my permission to the staff and volunteers to obtain the services of a licensed physician.  I understand that the staff and volunteers will make every attempt to notify me/us immediately concerning any such emergency. Checking the box below indicates your agreement to the terms above   *
Required
By registering your child in this program, your child may be photographed, videotaped, filmed on livestream feeds, and/or recorded as part of their participation in any of the church’s worship services and events, from the date hereof, and such video recording or photograph may be included in any church publications, website, or on the social media platforms of the Pluckemin Presbyterian Church of Pluckemin, New Jersey. No personal identifying information will be used. *
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