Parent's Night Out

NLC Kids Medical Release
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File Type:	pdf

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Medical Release must be submitted and on file along with Permission Form!

Parents Night Out Permission Form

* Indicates required field

Child's Name *

First

Last

Parent's Name *

First

Last

Emergency Contact Number *

Email *

I give my child, named above, permission to attend Parent’s Night Out with Pastor Donny NextGen at New Life Church (2080 19th st Springfield, OR). In the event of a medical emergency I give Pastor Donny Waite permission to authorize medical treatment. While there is always adequate adult supervision, I understand that my child is responsible for his/her behavior, attitude and safety. I do not hold New Life Church, the board members of New Life Church, congregation, or kids staff (volunteer and paid) liable in the event of an accident, emergency or behavior problem.
If my child is uncontrollable, dangerous, has a bad attitude or needs
extraordinary discipline I understand that I will be responsible to
immediately come pick them up from New Life Church in Springfield OR.

Parent's Consent *

Yes

Photo Release

The undersigned parent(s) or legal guardian(s) of my child in consideration of the benefits of the child participating in the activities of New Life Church, hereby grants New Life Church the right to photograph said child, and to use said photographs, regardless of the form thereof, which may included but not necessarily be limited to still format, digital format still or digital format video, to promote New Life Church youth or children’s ministry. It is understood and agreed that the photographic images taken by New Life Church or used by New Life Church for promotional purposes may be used in various forms, including but not necessarily limited to printed forms, transmission via internet, television or otherwise. The permission herein granted shall continue in effect unless revoked in writing.

Parent's Photo Release Consent *

Yes

Submit