Lake City Community Church

New Family Registration Form for 2019-2020

(10/9/2019) Warning: The Cubbies program (ages 3-5) is currently full, pending more volunteers.
You may still register your child, but you will be wait-listed.

Parent first name: *Street address:
*Parent last name: *City: Zipcode:
*Parent phone: *Email address:
Secondary phone: Emergency contact:
Emergency phone: * All the asterisked fields in red are required for registration.

*Parental consent: Scholarship discount requested:
Typical cost per child is $10 for book, $10 for shirt/vest, $35/year for dues)




I am willing to volunteer:

Parental consent:

In consideration for the participation of my child (children) in this program, I hereby waive, release and forever discharge Lake City Community Church, their agents, employees,
and anyone else connected with this program from any and all harm resulting from injuries sustained as a result of participation of my child (children) in this program.
I also grant the right to administer all medical services that may result from injuries during participation, including emergency and referral if necessary.
If there is any reason that my child (children) cannot remain with the church event for disciplinary reasons, it will be my responsibility and at my expense to get my child (children) home during said event.

I also give my consent for Lake City Community Church to use for church business candid photos of my child (children). Said photos are not permitted to be used by any other organization or business other than those affiliated with Lake City Community Church.