Please enable JavaScript in your browser to complete this form. form.) are child Participant(s) (Use the "+Add" to include more than one child on this form.) Participant's Name *FirstLastBirth DateAgeDoes this child have any allergies? *Additional Information: Add Remove Parent/Guardian Name *FirstLastAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail * Add Remove Additional Emergency Contact if Parent/Guardian can't be reached *Children's Classes end at 11:45 a.m., please have your child(ren) picked up by 11:55 a.m. What are the pick-up instructions for your child(ren): *TO WHOM IT MAY CONCERN: The undersigned does hereby give permission for this/these Participant(s), to attend and participate in Children’s Classes sponsored by GENERAL COUNCIL CHURCHES OF GOD, (Seventh Day), Inc. (General Council). LIABILITY RELEASE: In consideration of the General Council allowing the participant(s) to participate in the children’s classes, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless the General Council, its directors, employees, volunteers and agents (collectively herein the “church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant(s) while involved in the children’s classes. We (I) the parent(s) or legal guardian(s) of this/these participant(s) hereby grant our (my) permission for the participant(s) to participate fully in the children’s classes. Furthermore, we (I) [and on behalf of our (my) minor participant(s)] hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in the children’s class. Further, authorization and permission is hereby given to said church to furnish snacks for this/these participant(s) during class time. The undersigned further hereby agree to hold harmless and indemnify said church for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant(s), including expenses incurred attendant thereto. PHOTO RELEASE: The undersigned additionally gives permission for the General Council to publish photographs or video of my child(ren) taken during the children’s classes on the General Council website, social media and other General Council related media (i.e. ACTS magazine). Parent/Guardian Signature Clear Signature Submit