EPIC Registration (Grades 9-12)

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EPIC will meet from 7-8:30 on Wednesdays

Child's Name: *

Grade Level for 22-23 *

Child's Phone Number *

Second Child's Name

Second Child's Grade level for 22-23

Second Child's Cell Phone Number (if applicable)

Parent's Names *

Address *

Parent Phone Number *

Parent email *

Disclaimer: I, the parent and/or guardian to the above children, give permission for my child to attend and participate in activities sponsored by Living Water. I, authorize an adult, in whose care the minor has been entrusted, to consent to any emergency medical care if I cannot be reached. The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical services. The undersigned does also give permission for my child to be a passenger in any vehicle that has adequate insurance. *

I agree to the above statement and give Living Water my permission

I do not agree to the above statement and do not give Living Water my permission

MEDIA RELEASE: By submitting this form, you give permission for the children listed below to be photographed and/or video/audio taped at Living Water Church or at events sponsored and/or approved by Living water. I understand that these photos or video/audio tapes may be used for instruction purposes, presentations, general uses for the children, and other things throughout the church. These photos may also be displayed on bulletin boards at Living water, the Living Water website, the Living Water Facebook pages, sent into the local media, or used in brochures promoting the church, youth and/or children programs, and/or mission projects. *

Yes, I give Living Water permission to photograph my child(ren)

No, I do not give Living Water permission to photograph my child(ren)

A required parent meeting will be held on Wednesday, September 21st at 6:00. Please plan to attend. *

I understand and will make every effort to attend

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