Make a Splash with Jesus
Event Timing: June 29, 2019  9am-2pm
Event Address: 1323 Goshen Road  Rincon, GA 31326
Contact us at goshenroadbaptist@gmail.com or visit our website at www.goshenroadbaptist.org

This will be a day filled with God's Word, singing, crafts, games,  and water fun! A snack and lunch will be served. We will also have water slides for the children's enjoyment. Please provide your child with a one-piece bathing suit (girls) or a dark colored t-shirt over the swimsuit, towel, sunscreen if needed, and a set of dry clothes to change into.
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Child's Name *
Parent's Name *
Mailing Address *
City, State      Zip *
Phone Number *
Email Address
Child's Birthdate *
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YYYY
Please select the group for the last grade complete in school. *
Please list any medical or other information we need to know.  Please include any food allergies.
Emergency Contacts (list names and numbers) *
Dismissal Information - Who may pick up your child at the end of the day? *
Do you attend a church regularly? *
If so, list your home church
Release of Liability
By signing this Permission and Waiver Form, I release the church and its ministers, leaders, employees, volunteers, and agents from any claim that my child may have or that I may against them as a result of injury or illness incurred during the course of participation in this event. This release of liability is also intended to cover all claims that members of the child’s or my family or estate, heirs, representatives or assigns may have against the church or its ministers, leaders, employees, volunteers, or agents. I further agree to indemnify and hold harmless the church and its ministers, leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during this event.
First Aid and Emergency Medical Treatment
 I recognize that there may be occasions where the child named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of the church to seek and secure any needed medical attention or treatment for the child named above including hospitalization if in the agent’s opinion such need arises. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment.
Photo Release Form
 I hereby grant permission to Goshen Road Baptist Church to use my photograph(s) on its Web site or in other official church printed publications without further consideration.  I acknowledge that the church may choose not to use my photograph(s) at this time, but may do so at its own discretion at a later date. I also understand that once my image is posted on the church’s website, the image can be downloaded by any computer user, anywhere in the world. Therefore, I agree to indemnify and hold harmless the church, its trustees, pastor, associate pastors, deacons, its members and designees from any claims arising out of the use of my photograph(s).
Electronic Signature- By typing my name I agree to the information stated above. *
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