Sunday School Registration

Child's Name

Child's Birthday

Parent/Guardian Name

Parent/Guardian email

This address will receive a confirmation email

Parent/Guardian Work/Cell Phone

Address (physical address of child/family)

I give consent for any photos of my child taken during Sunday School to be used in media and publications such as the Arkive and Ark & Dove website. YES NO

Emergency Contact Name

Emergency Contact Phone

Please list any allergy, dietary or medical concerns

Please indicate if your child has any special academic needs.

I hereby understand that my child will be supervised and that if a health problem or injury arises, I will be notified. If I cannot be reached by phone, medical treatment and/or hospital care will be administered by competent medical personnel including medication, injections, anesthesia, surgery, or other proper treatments and necessary information may be released for insurance purposes. I verify that all health issues are so noted on this form.

YES NO

LIABILITY RELEASE: In consideration of Ark and Dove allowing the above child(ren) to participate in Sunday School activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless Ark and Dove, its directors, employees, volunteers, and agents (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above child(ren) while involved in Sunday School. Furthermore, on behalf of my minor child(ren), I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein.

YES

COVID WAIVER: For Sunday School participation during the COVID-19 virus epidemic, I also voluntarily accept, acknowledge my agreement, and will follow, as parent or guardian on behalf of myself and my child, the following conditions or requirements: 1. Based on the COVID-19 virus, I verify that neither myself nor my child is showing any symptoms of COVID-19, including cough, shortness of breath or difficulty breathing, or at least two of the following: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell. 2. I accept, agree and acknowledge that if my child develops these or other related symptoms that they will not participate in the nursery. 3. If they test positive for Covid they will not participate in the nursery for 5 days after onset of symptoms or positive test and will wear a mask for 10 days after symptoms, unless they have two negative rapid at-home antigen tests 48 hours apart they may stop wearing a mask after day 5.

YES

I accept, acknowledge and understand that Ark and Dove and Ark and Dove staff will, to the best of their ability, require and enforce all applicable requirements which may assist in offering protection from the COVID-19 epidemic, as specified in the Center for Disease Control guidelines, including but not limited to cleaning and hand washing, but understand the atmosphere of the program may not allow perfect enforcement and assume the risk participation and waive and release the Church, its agents, servants, and employees, from all claims and liabilities of any kind related to that participation or any requirement imposed as the Ark and Dove staff makes their best efforts to comply with the guidelines.

YES

I acknowledge that the information I provided on this form is accurate, to the best of my knowledge:

YES

Sunday School Registration

Description

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