Please be specific with this information so we can best assist your children.
Please answer yes or no if you are okay with the nursery volunteers changing your children/child's diapers. (Please answer if your child if your child falls under this category)
In consideration of my child’s (name listed above) opportunity to participate in Lighthouse Church’s activities and programs, I acknowledge and accept the risks of injury associated with participation and transportation to and from any and all activities and programs of Lighthouse Church. I accept personal financial responsibility for any injury or other loss sustained during the activities or programs of Lighthouse Church or during transportation to and from such activities and programs, as well as for medical treatment rendered to my child that is authorized
by Lighthouse Church, its leaders, employees, volunteers, or agents. I specifically consent to allowing my child to be transported to receive emergency care and to be responsible for all financial charges for such emergency care.
I release and promise to indemnify, defend, and hold harmless Lighthouse Church, its leaders, employees, volunteers, and agents from any and all injury or loss arising directly or indirectly out of the activities and programs of Lighthouse Church or transportation to and from such activities and programs, whether such injury arises out of the negligence of Lighthouse Church, my child, or otherwise.
I, guardian of the child's (name listed above), hereby grant, voluntarily and with full understanding, to Lighthouse Church, a license to the following:
1. Use and storage of my name and image, by means of digital or film photography, video photography,
audio recording, or other documentation, with respect to the activity, of the Church.
2. Use of any stored data including my name and image in printed publications of Church.
3. Use of any stored data including my name and image in electronic publications of Church.
4. Use of any stored data including my name and image in any Web site created by or for Church for its
sole benefit.
5. If I am signing this agreement on behalf of a minor child, I hereby warrant that I am the legal
parent or guardian of the child and that I have the legal authority to sign this agreement on behalf of
the child.
6. If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter
through a mutually acceptable alternative dispute resolution process. If I cannot agree with
Church upon such a process, the dispute will be submitted to a three-member arbitration panel for
resolution in accordance with the rules of the American Arbitration Association for final resolution.
