Love, Joy, Peace...
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LPC Kids (Compass Kids and Wayfinder Wednesday) Waiver
While every reasonable precaution is taken for the safety and health of your child we understand that accidents, illness, or other unforeseen circumstances may occur. By granting consent below, you acknowledge and agree to the following: Assumption of Risk: I understand that participation in the Kids Programs at LPC may include, but is not limited to, games, sports, transportation, and other physical activities. I acknowledge that there are inherent risks involved and accept responsibility for my child’s participation. Release of Liability: To the fullest extent permitted by law, I release and hold harmless Listowel Pentecostal Church, its staff, volunteers, and representatives from any and all claims, demands, actions, or causes of action arising out of my child’s participation in these activities. Medical Consent: In the event of sickness or accident, I authorize LPC, its staff, or volunteers to secure such medical attention as may be deemed necessary. Should my child require medication, X-rays, hospitalization, anesthesia, or surgery, I consent to such treatment and understand that every effort will be made to contact me immediately. Insurance Requirement: I confirm that my child is covered by Provincial Health Insurance or equivalent medical insurance. Confidentiality: I understand that the information provided in this form will remain private and confidential, unless required in the event of an emergency. Off-Site Events: I understand that any event held off church property will require separate documentation and permission. Student Conduct: I acknowledge that my child is expected to follow all safety instructions and behave respectfully. LPC reserves the right to dismiss any child whose behavior is deemed unsafe or disruptive.
Your Name: (Required)
Your Email: (Required)
Your Phone Number: (Required)
Your Address: (Required)
Childs Name: (Required)
Child's Birthday (Required)
Child's Gender :
Allergies or Medical Info: (Required)
Emergancy contact: (Required)
In the event of an emergency, who would we contact? Please provide name & phone number.
Photo Release: (Required)
Does Listowel Pentecostal Church have full permission and authorization to take pictures of your child for use of in-house activities, social media and advertising?
Does your child have any physical, emotional, mental, learning, or behavioural concerns or differences we should be aware of??
If yes, please explain.
Provincial Healthcard Number: (Required)
Name and phone number of family physician: (Required)
By selecting "Yes" on this document I confirm that I am the parent/legal guardian of the named child. I acknowledge that this selection constitutes my legal signature and consent for this child to participate in the children's programs at Listowe (Required)
Solve 4 + 5 = ?