WEDNESDAY NIGHT KIDS REGISTRATION

PARENT RELEASE AND ELECTRONIC SIGNATURE: I, the parent or guardian of above named child, agree to allow my child to participate in the activities at Park Christian Church. I understand that reasonable effort will be made to prevent injury to my child. I will not hold Park Christian Church, or any of its staff or volunteers, liable for injury or loss to my child. I understand that media footage or promotional & educational efforts may cause my child's image to be captured or video to be taken thereof. I give permission for my child's images and videos to be used for such promotional and educational purposes. I further understand the rules of conduct, and understand that my child may be sent home if they are not complying with Park Christian Church's rules of conduct during the event.

PARK CHRISTIAN CHURCH

Ph: 740.922.4118
Fax: 740.922.6113

Email: parkchurchoffice236@gmail.com

www.parkchristian.org

236 Miller Avenue

Dennison, OH. 44621

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