Thursday Night LIVE/Kingdom Kids Registration Form Which event are you registering for?(Required)Select an EventWednesday Night LIVEKingdom Kids (Not available during summer)Name(Required) First Last Age(Required)Select Age123456789101112131415161718192021Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Emergency Contact(Required)Enter an emergency contact Name and Phone Number.AllergiesPlease list any allergies. If none, enter NA.Photo/Video WaiverI hereby grant Covenant United Methodist Church permission to use my child in photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of Covenant United Methodist Church and will not be returned. I hereby irrevocably authorize Covenant United Methodist Church to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge Covenant United Methodist Church from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS. I agree to the photo/video waiverCAPTCHA
