KidZone Registration Form

Bear Creek United Methodist Church
16000 Rippling Water Drive
Houston, TX 77084
bearcreekumc.org

Participant Information

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Household / Adult Primary Contact

Relationship to Participant: *
 

Emergency Information

Release Authorization

As part of our Safe Sanctuary Policy, all children participating in KidZone programs must be picked up by a parent or person designated by a parent or legal guardian.
 
I give my permission for my children to be picked up from KidZone programs by the following person(s):
Program(s) *

Other Agreements / Authorizations / Releases

Consent to Treat - By signing below, I hereby give my permission to the physician selected by the BCUMC trip coordinator or adult in charge to order X-rays, routine tests and provide treatment for the health of myself, my spouse, and/or my child, hospitalize, secure proper treatment for and to order injection(s) and/or anesthesia and/or surgery for myself, my spouse, and/or my child as named above in the event that the emergency contact cannot be reached.
Transporation Release - By signing below, I authorize transporation for myself, my spouse, and/or my child by emergency vehicle to an appropriate health care facility and pre-hospital medical care, all hospital and physician services, whether medical, surgical and/or dental, necessary for the benefit/safety/well-being of myself, my spouse, and/or my child.
Hold Harmless Agreement - By signing below, I, knowing that Bear Creek United Methodist Church has general liability coverage, but that no accident policy is being carried out for this program, do assume all risks and hazards incidental to the conduct of its activities; and do further indemnify and hold harmless the Bear Creek United Methodist Church, the organizers, sponsors, volunteers, drivers and workers associated church sponsored events and activities. In case of injury to myself, my spouse, and/or my child, I hereby waive all claims against Bear Creek United Methodist Church, the organizers, sponsors, volunteers, drivers and workers associated with church sponsored events and activities.
I have read and agree to the statements above.
Photography Release - I hereby grant permission for photographs, video and audio recordings of myself, my spouse, and/or my child while he or she participates in the activities associated with BCUMC, and I agree that BCUMC shall own all rights, copyrights, and derivative works. I give my irrevocable and perpetual consent to BCUMC to use, distribute and publish the photographs, videos and audio recordings of myself, my spouse, and/or my child for internal and promotional purposes, including posting at the church, broadcasting as audio programs, displaying as slide show or video presentations, inclusion in printed materials, and inclusion in online publication, presentations, and social media sites, such as, Facebook, Twitter, and YouTube.
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