Home
Know Jesus
About
Meet Dr. Mallette
Sunday @ King's
What We Believe
Missions
Media
Live
Give
Connect With Us
Connect Card
Prayer Request
Who is your One?
REGISTRATION
I hereby authorize the participation of the above-named child in activities of King's Church Las Vegas. In consideration of King's Church providing these activities, I, on behalf of myself and other parents and guardians of the minor, do hereby release King's Church, its officers, employees, agents, and members of the Board of Elders from all claims and causes of action by reason of any injury which may be sustained as a result of these church activities, whether on the church premises or on the way to or from these activities. I agree to direct my child to cooperate and to conform with directions and instructions of personnel of the organization in charge of these activities. I understand and agree to leadership having access to my child's room when necessary.
I hereby give my permission to the physician, nurse, or dentist selected by King's Church to secure medical or dental aid as required for illness or injury under a physician's orders, including transportation to and from necessary facilities. As a participant, I understand King's Church is not obligated to carry any insurance to cover those medical and/or dental expenses. I understand that my personal insurance is my primary coverage. This authorization shall remain effective until revoked in writing delivered to King's Church Las Vegas.
I acknowledge that pictures of my youth may be taken while attending Camp Regen. I also acknowledge that pictures may be posted to our social media or website for the purpose of illustrating the activities at King's Church. Any pictures posted to our social media or website are considered to be the property of King's Church and may not be sold or reused without the express consent of King's Church. Parents who have special concerns or requirements regarding photography of their children agree to submit a "do not photograph" form to the King's Church administration office in advance of the activities.
Parent/Guardian's Name
Parent/Guardian's Name
Address
Phone Number
Emergency Phone Number
Email Address
#1 Youth's Name
Date of Birth:
If Youth #1 has any allergies, medical concerns, or special learning needs, please state below.
#2 Youth's Name
Date of Birth:
If Youth #2 has any allergies, medical concerns, or special learning needs, please state below.
INSURANCE INFORMATION: Name of Company
Policy/Member Number:
Group Number:
Company Phone Number:
Physician's Name:
Physician's Phone Number:
The undersigned has read the foregoing disclaimer, agrees to its terms, and hereby gives consent for the above-stated child(ren) to attend Camp Regen. ELECTRONIC SIGNATURE REQUIRED (Please Type Name):
Send
