Hucrest Community Church of God
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    *Please fill out a separate form for each child

    Register for SonSpark Labs VBS!
    June 20-24th, 9:00 am to Noon

    Please fill out a separate form for each child.
    Please list.
    I hereby give my consent to have my minor child participate in the following activity of Hucrest Community Church of God in collaboration with Roseburg Alliance Church: Vacation Bible School (hereafter “the activity”) on or about June 20, 21, 22, 23, and 24, 2016. I recognize that there are risks involved in participating in this activity and hereby assume all risk of injury, harm, damage, or death to my minor child in connection with his-her participation in this activity. To the fullest extent permitted by law, I release Hucrest Community Church of God and Roseburg Alliance Church, their trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless Hucrest Community Church of God and Roseburg Alliance Church, their trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child's participation in the activity. Further, being the parent or legal guardian of the minor child, I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child. I understand that efforts will be made to contact me prior to treatment but, in the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. As parent or legal guardian, I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child. Any insurance policy of the church or organization sponsoring this event will be used as the secondary coverage.
    To sign, please type your full legal name.
Submit
Emergency Consent Form
File Size: 114 kb
File Type: pdf
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Hucrest Community Church of God
2075 NW Witherspoon Ave.
Roseburg, Oregon 97471
541-673-7073
Office Hours: By Appointment  
Webmail Access
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  • Home
  • About
    • I'm New
    • Staff
    • Find Us
  • Sermons
    • September 2020
    • August 2020
    • July 2020
    • June 2020
    • May 2020
    • April 2020
    • March 2020
    • February 2020
    • January 2020
    • December 2019
    • November 2019
    • October 2019
    • September 2019
    • June 2019
    • May 2019
    • April 2019
    • March 2019
    • December 2018
    • November 2018
    • October 2018
    • September 2018
    • August 2018
    • July 2018
    • June 2018
    • May 2018
    • April 2018
    • March 2018
    • February 2018
    • January 2018
  • Resources
    • Prayer
    • Calendar
    • Pastor Jon's Blog
  • Give
  • Contact