Abiding grace Lutheran Church

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Christmas For Kids 2012 Online Registration

By electronically submitting this form, you hereby give consent as the parent/guardian for the child/children listed above to participate in Abiding Grace Lutheran Church's Christmas For Kids program held at Abiding Grace Lutheran Church in Covington GA. You and your child/children hereby release, indemnify, and hold harmless the church, its employees and/or volunteers from any and all liabilty for any claim, injury, or loss sustained by or during my child's participation. You furthermore authorize Abiding Grace to take and use photographs and/or video of my child for crafts, keepsakes, or promotional purposes in anytype of media and understand you will not be compensated for any such use. In the event of an emergency, the staff has your permission to seek necessary medical treatment for your child/children.

Child #1 Name Age
Child #2 Name Age
Child #3 Name Age
Parent/Guardian Name
Address,City,State,Zip
Email Address
Phone Number
Cell Phone Number
Who, other than you, will be picking up child/children?
Do you have a home church?

If Yes, Where?
Any allegies or special needs we should be aware of?
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