Great Pumpkin Hunt 2020

FRIDAY, OCT 30 :: 6 - 9PM

We will be meeting in the LBAC Backyard.

REMINDER: DUE TO COVID-19

STUDENTS WILL BE REQUIRED TO BRING A MASK.

Student Information

Name*

First Last

Grade*

Please enter the grade your student is currently in.

Is your student coming as a friend with one of our students?

Yes
No

What is the name of that friend?*

Parent Information

Name*

First Last

Phone*

Email*

Permission Slip

Please read the following information and click the box next to each statement acknowledging you've read it and agree with it.

Parent/Guardian acknowledgment of the following statements:*

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Checking this circle acknowledges that my child has permission to participate in Long Beach Alliance Church’s Great Pumpkin Hunt. To the best of my knowledge, my child is healthy and fit for an active program event. I acknowledge that there may be inherent possibility of risk (including but not limited to: minor bumps and bruises, choking, shark attacks, injuries from vehicle accidents, etc.), and agree to hold harmless Long Beach Alliance Church, its employees and volunteers for any loss, damage, injury, disease or death which results from this activity. In case I cannot be reached in an emergency, I hereby give my permission to the licensed health care provider selected by Long Beach Alliance Church to secure medical treatment including hospitalization, injections, anesthesia or surgery as may be deemed necessary for the child listed above. I also understand and agree that I am responsible for all expenses incurred in the event of an emergency.
I understand the Long Beach Alliance Church staff, volunteers, and leaders will make every attempt to contact me as soon as possible in the event an emergency arises. If contact cannot be made, I authorize the Long Beach Alliance Church staff, activity volunteers, and leaders to provide medical care, and if necessary, take my child to a doctor or medical facility. I also authorize medical treatment recommended by medical staff and I assume responsibility for all medical costs.
I, on behalf of my child, myself, my children, my assigns, and my estate, assume the risk and promise to release from liability and hold harmless for personal injury or sickness and/or damage to personal or public property resulting from my child’s participation, Long Beach Alliance Church, its officers, Governing Board, Elders, agents, employees, and/or volunteers for any and all claims for injuries, causes of action, or liability related to my and/or my minor child’s participation in the above Long Beach Alliance Church youth onsite or offsite activity. This release does not apply to intentional and/or willful acts of misconduct by Long Beach Alliance Church or any of its officers, Governing Board, Elders, agents, employees, and/or volunteers.
I agree to indemnify and hold harmless the Long Beach Alliance Church, its officers, Governing Board, Elders, agents, employees, and/or volunteers for any liability incurred or property damage/loss sustained by Long Beach Alliance Church as the result of the negligent, willful, or intentional conduct of my child, including expenses attendant thereto.
I hereby certify that I have read and clearly understand these terms and that this authorization/waiver/covenant is being executed voluntarily.

Insurance Provider*

Insurance ID#*

Known Allergies*

Is there anything specific that Pastor Jesse should know that hasn't been asked or disclosed?

By typing your name in the space below, you are giving permission for your student to attend this event, as well as affirming the accuracy of this form..*

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