Parent or Legal Guardian's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent or Legal Guardian's Phone *

(###)

###

####

Child's Name *

First Name

Last Name

Child's Birthday *

MM

DD

YYYY

Child's Name

First Name

Last Name

Child's Birthday

MM

DD

YYYY

Child's Name

First Name

Last Name

Child's Birthday

MM

DD

YYYY

Child's Name

First Name

Last Name

Child's Birthday

MM

DD

YYYY

Child's Name

First Name

Last Name

Child's Birthday

MM

DD

YYYY

Release of Liability *

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold Los Angeles Baptist Church and its pastor, officers, agents, employees, teachers and all volunteers harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future, in connection with participation in the described activity or in any other associated activities. In the event any disagreement or conflict arises from any activity connected to this authorization and release, I knowingly and expressly agree to have such conflict resolved in accordance with the alternative Dispute Resolution procedures developed by Los Angeles Baptist Church, and agree to binding arbitration, expressly waiving any and all rights in law and equity to bring any civil disagreement before a court of law.

Yes

No

I need transportation for my children (pick-up and/or drop-off):

Yes

No