1st Student's Name

First Name

Last Name

Registering for (select one): *

BBC Kids (grades K-5)

Youth Group (grades 6-12)

Phone

(###)

###

####

2nd Student's Name

First Name

Last Name

Registering for (select one):

BBC Kids (grades K-5)

Youth Group (grades 6-12)

Phone

(###)

###

####

3rd Student's Name

First Name

Last Name

Registering for (select one):

BBC Kids (grades K-5)

Youth Group (grades 6-12)

Phone

(###)

###

####

Physical Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Terms and conditions: I consent to and approve my child/children’s taking part in any and all activities conducted by BBC KIDS. I understand that my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and consent to the treatment of any minor injuries of my child/children, and release, hold harmless and indemnify BBC KIDS and the Church and their officers, directors, agents, employees and volunteers from any and all liability, claims and costs arising from or growing out of such treatment. In the event of an emergency that requires medical treatment for the above-named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the BBC KIDS volunteers to secure the services of a licensed physician to provide the care necessary for my child’s well-being. I assume responsibility for all costs connected to any accident or treatment of my child. I give permission for photo(s) of my child/children to appear among other general club photos in any and all media as long as there is no identifying information published by BBC KIDS. I hereby waive any causes of action I may have because of the use of my child’s photograph. *

I have read the Terms & Conditions stated above.

Parent / Guardian Electronic Signature *

First Name

Last Name