Family Ministry Registration Form

Child Name
Child Date of Birth
Additional Child Name
Additional Child Date of Birth
Additional Child Name
Additional Child Date of Birth
Additional Child Name
Additional Child Date of Birth
Additional Child Name
Additional Child Date of Birth
Additional Child Name
Additional Child Date of Birth
Cell Phone
Emergency Contact Name
Emergency Contact Phone
Is there any special info about your child/youth?

Image Use

I, the undersigned, do hereby grant or deny permission to First Presbyterian Church of Annapolis to use the image of my child(ren) named above as marked by my selection(s) below. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child/children for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the First Presbyterian Church of Annapolis Web site.

Grant with unrestricted usage: I give unrestricted permission for my child(s)'s image to be used in print, video, and digital media. I agree that these images may be used by First Presbyterian Church of Annapolis for a variety of purposes and that these images may be used without further notifying me. I do understand that the child(s)'s last name will not be used in conjunction with any video or digital images.

Permission you are granting
Signature
Date

Permission

By checking the box below, I state that: 
I am a parent or legal guardian of the child whose name is on this form. This youth has my permission to participate in First Presbyterian Church of Annapolis activities both on and off property. It is my understanding that First Presbyterian Church of Annapolis and its leaders will not to be held liable for anything that may occur while on or off church property. I hereby give permission for any adult leaders, advisor, or chaperone to authorize all medical care and treatment as may be reasonably necessary during any church activity. I agree that I will be responsible for the payment of all medical charges incurred.