Home
Main
About
What We Believe
Leadership
More Info
Contact
Children
Womens Ministry
Mens Ministry
Prayer Request
Messages
Foundations
Events
Give
Connect Card
REGISTRATION IS OPEN
Empowered To Stand - Kids 3 Day Conference
*Ages 6-13*
4484 N. John Young Pkwy Orlando, FL 32804
Your Full Name (Parent/Guardian)
Relation to child(ren)?
Phone Number
Address 1
Address 2
Country
City
State
Zip/Postal Code
Email Address
Emergency/Alternate Contact Full Name
Relation to child(ren)?
Phone Number
Email Address
Is the emergency/alternate contact allowed to pickup the child(ren)?
----
Yes
No
Please list anyone else authorized to pick up kids here along with their phone number.
Name (Child 1)
Date Of Birth
Name (Child 2)
Date Of Birth
Name (Child 3)
Date Of Birth
Name (Child 4)
Date Of Birth
Please list any allergies or medical conditions and their severity that the children may have as well as which child has them. If none, enter N/A
*Team Members will not administer ANY medications. In the event of an emergency, RCA teachers and staff will call 911.
I understand and agree with this policy.
I hereby waive, release and discharge any and all claims for damages for personal injury which may hereafter occur to my child as a result of participating in said event. This release is intended to discharge in advance Revelation Church Orlando, Revelation Christian Academy, Church In The Son, their officials, officers, employees, volunteers and agents from liability. I give consent for my child/children listed above on this form to participate in all “Empowered To Stand – Kids 3 Day Conference” activities hosted by Revelation Christian Academy on February 20th-22nd during the hours of 12pm to 2pm. All while under adult supervision. I also give Revelation Church Orlando or Revelation Christian Academy permission to publish in print, electronic or video format the image or video of my minor child. I release all claims against all parties listed with respect to copyright ownership and publication including any claim for compensation related to the use of the materials. I hereby execute the above liability release and minor photo/video release on my listed children's behalf. Should I have any questions about any activities or do not wish for my child(ren) to participate in a specific event I will make this known to Revelation Church Orlando or Revelation Christian Academy staff and do so before signing this form. By providing consent below I declare that I am the parent/legal guardian of the child(ren) listed above and that all information entered is accurate.
I understand and agree.
Enter your initials to sign this form
Date Confirmation Provided(Enter Current Date)
SUBMIT
