By submitting this registration you will be agreeing to our Consent and Agreement form.  Please take the time to read this before submitting your student's registration.

EBENEZER REFORMED CHURCH

 PARENT GUARDIAN CONSENT AND AGREEMENT

  As the parent/legal guardian of the above named minor(s), I give my permission for him/her/them to participate and be transported to and from church related activities.  I acknowledge and accept the risks of injury associated with participation in and transportation to and from the activity.  I accept personal financial responsibility for any injury sustained during the activity or during transportation to and from the activity.  Further, I promise to indemnify, defend, and hold harmless the activity sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the "Sponsor") for any injury related directly or indirectly out of the activity or transportation to and from the activity, whether such injury arises out of the negligence of the Sponsor or otherwise.

 In the case of a medical emergency, I understand that every reasonable effort will be made to contact me.  In the event I cannot be reached, I hereby grant permission to a licensed physician to hospitalize, secure proper treatment for, and/or to order injection, anesthesia, or surgery on my son(s) or daughter(s).

 I will contact the church if the health insurance or contact information above needs to be changed.

 I give permission for any photographs or video of my child(ren) taken during events to be used in Ebenezer Reformed Church Publications.

 I understand if it is necessary for my child(ren) to be returned home for dismissal or accident, I will be called to come for him/her/them at my own expense.

 Note:  Riders on the church van will be dropped off at the address on the consent form unless prior arrangements have been made with a signed note from the parent. 

 This consent and authorization shall remain in effect until September 1, 2019 unless parental notification is received in writing prior to this date.