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Crosswalk Enrollment
Doug Fleck
2022-08-09T15:31:22-05:00
CrossWalk Wednesday Evening | Children Registration
"
*
" indicates required fields
Parent/Guardian Name
*
Parent or Guardian, please enter your name.
First
Last
Email Address
*
Please enter an email address. All communication concerning Wednesday Evening Crosswalk will be via email.
Phone
*
Please enter a number where you can be contacted in the event of an emergency during Crosswalk.
Number of Children?
*
Up to 4 Children
Please enter a number from
1
to
4
.
1st Student's Name
*
Please enter your students name.
First
Last
Current Grade Level 1st Student
*
Please select the grade your student is currently enrolled.
PreK
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
2nd Student's Name
*
Please enter your students name.
First
Last
Current Grade Level 2nd Student
*
Please select the grade your student is currently enrolled.
PreK
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
3rd Student's Name
*
Please enter your students name.
First
Last
Current Grade Level 3rd Student
*
Please select the grade your student is currently enrolled.
PreK
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
4th Student's Name
*
Please enter your students name.
First
Last
Current Grade Level 4th Student
*
Please select the grade your student is currently enrolled.
PreK
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Consent
*
I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this event. I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Timothy Lutheran Ministries, their officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in this event, or while on or upon the premises where the event is being conducted. It is my expressed intent that this release and Hold Harmless Agreement shall bind the members of my family, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, and CONVENTION TO SUE the above names RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the State of Missouri. Completion of online registration signifies that I acknowledge and represent that I HAVE READ THE FORGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME. Any concerns regarding photo release MUST BE FORWARDED TO ryanh@timothylutheran.com PRIOR TO ATTENDING YOUR FIRST EVENT, to insure proper treatment of exceptions. I hereby grant permission to Timothy Lutheran Ministries (the church) to use my photograph(s) on its World Wide Web and Social Media sites or in other official church printed publications without further consideration and until otherwise revoked, and I acknowledge the church’s right to crop or treat the photograph(s) at its discretion. I also acknowledge that the church may choose not to use my photograph(s) at this time, but may do so at its own discretion at a later date. I also understand that once my image is posted on the church’s website, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless the church, its executive board, pastor, associate pastors, elders, its members and designees from any claims arising out of the use of my photograph(s). The church reserves the right to discontinue use of any photograph(s) without notice.
I have read and agree to the terms of this waiver.
Liability & Photo Release Waiver
Additional Comments:
Please enter any allergies or medical conditions and/or additional comments, concerns, you may have that should be brought to the attention of our volunteers and staff.
Email
This field is for validation purposes and should be left unchanged.
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