Parent 1 Name *

First Name

Last Name

Phone

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Parent 2 Name

First Name

Last Name

Phone

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child 1 Name *

First Name

Last Name

Child 2 Name

First Name

Last Name

Child 3 Name

First Name

Last Name

Emergency Contact *

First Name

Last Name

Emergency Contact Cell Phone *

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I understand that it is my obligation to inform the staff of FUMC CV of any and all health considerations or medical conditions that would restrict my child's participation in any and all activities while in the care of First United Methodist Church of Chula Vista. Should the need for medical attention arise the church will attempt to contact me as soon as practicable under the circumstances. In cases of emergency, I further consent to the examination or treatment of my child by a physician duly licensed to practice medicine in the United States of America or any health care professional duly licensed to provide health care serviced in the United States of America for medical care and services deemed necessary by the doctor, its agents, servants, and employees. I give permission to the doctor or health care professional to provide any and all medical care they deem, in their professional opinion, to be necessary. I agree to pay for any and all medical expenses incurred as a result of the use of this consent. I acknowledge by signing this document that if anyone is hurt or property is damaged during my child's participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against the church on the basis of any claim form which I have released them herein. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions remain in full force and effect. I have fully informed myself to the contents of this PARENTAL AUTHORIZATION, CONSENT AND RELEASE by reading it before I signed it. *

Type name below

First Name

Last Name

Date *

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This checkbox will be your electronic signature. Please check yes if you agree to the terms of this Release of Liability. *

Yes, I agree to the terms of this release of liability and this is my electronic signature.

I am aware that photographs or video may be taken of First United Methodist Church Chula Vista (FUMCCV) Children's Ministry participants during events, activities, and classes by FUMC CV volunteers and staff members, professional volunteers, news media or volunteers. I also understand that my child is not required to have his/her picture taken. I waive the right to see or approve of publications that contain photographs of my child. I release FUMCCV and its representatives from responsibility for any harm or invasion of privacy that may occur or be produced by taking photographs or video of my child. I give FUMC CV and its representatives permission to use photographs or video that include my child in any and all media products for promotion, art, advertisements and editorial purposes. This may include but is not to newsletters both print and email, posters, brochures, ads, postcards, and web pages. I certify that I have read the above authorization, release, and agreement, and fully understand what this document says. *

Yes, I agree to the above stated photo release.

No, I do not agree to above stated photo release.

I understand that I will have to secure payment online at or in person at the FUMCCV church office. *

Yes