Online Permission Form

RVCC Registration Form (Children & Youth)

* Indicates required field

Child's Name *

First

Last

Parent/Guardian Name(s) *

Parent/Guardian Phone Number *

Alternate Parent/Guardian Phone Number *

If I cannot be reached in the case of an emergency, please call (name and phone) *

Address, City, Zip *

Child's Birthday *

School *

Grade *

Special Needs or Allergies (including food and medication) *

Other Adults Who May Pick Up Your Child *

Emergency/Medical and Permission Consent Form
I, the undersigned, as legal guardian of a minor, give my permission for the above named to participate in all children’s activities associated with Rim View Community Church (RVCC). I release, discharge and agree to hold harmless (RVCC), it’s staff and volunteers from any and all liability, claim or demands for personal injury, illness or death, as well as medical and property damage expenses of any nature whatsoever which may be incurred by us and/or my (our) child while my (our) child is participating in church related activities (including transportation to and from events), hereby assuming all risk and expense as a result of participation. I shall be liable for and agree to pay all costs and expenses incurred in connection with any medical or dental treatment rendered pursuant to this authorization. Any pictures of my child taken during participation in church sponsored activities may be used in electronic or paper promotional material, including social media, associated only with the church. In the case of medical emergency, I understand that every effort will be made to contact the parent(s) or guardian(s) of my child. In the event that I cannot be reached, I give permission to the physician attending my child to hospitalize, secure proper and necessary treatment for my son/daughter as named herein. I give permission for the release of medical records to an attending physician in case of injury or illness. I have fully read this form and sign voluntarily with knowledge of its terms and conditions.

I acknowledge the terms above and agree to them. *

I agree.

Parent/Guardian Electronic Signature *

I am this child's... *

Parent Legal Guardian

Submit

RVCC Registration Form (Children & Youth)

We Would Love to Have You Visit Soon!

Pastor Dave

Church phone

Address