LOGOS Registration 2024-2025

Parent/Guardian Name

Parent/Guardian email

This address will receive a confirmation email

Parent/Guardian Work/Cell Phone

Address (physical address of child/family)

Emergency Contact Name

Emergency Contact Phone

Child #1 Name

Child #1 Birthday

Child #1 Grade

Please list any allergy, dietary or medical concerns of child #1

Please list any special information about child #1 that might help LOGOS leaders (behavioral, academic, emotional needs, etc.)

Child #2 Name

Child #2 Birthday

Child #2 Grade

Please list any allergy, dietary or medical concerns of child #2

Please list any special information about child #2 that might help LOGOS leaders (behavioral, academic, emotional needs, etc.)

Child #3 Name

Child #3 Birthday

Child #3 Grade

Please list any allergy, dietary or medical concerns of child #3

Please list any special information about child #3 that might help LOGOS leaders (behavioral, academic, emotional needs, etc.)

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

LOGOS DINNER PLANNING: Dinner is offered on 10-22, 11-19, and 12-17 of 2024, for registered children, their families, and other LOGOS volunteers. Beginning in January of 2025 we are considering the addition of Family Time to each week of the program. Called "Family Time", it is an opportunity to build relationships and share a meal with your church family. Please note: LOGOS children will be sitting with their age group and leaders. Additional family members are invited to sit at our adult table. Please list any additional family members you expect to attend beyond your child and any allergies or food sensitivities we should know about so that we can prepare enough food and place settings.

I hereby understand that my child(ren) 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

LIABILITY RELEASE: In consideration of Ark and Dove allowing the above child(ren) to participate in LOGOS 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 LOGOS. 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 LOGOS 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. I accept, agree and acknowledge that if my child(ren) develops these or other related symptoms during the program, or I or my child(ren) or anyone in the child’s household tests positive for COVID-19, that we will follow the current CDC guidelines regarding management of the case and/or exposure.

YES

2. I understand that wearing a mask is optional during LOGOS and anyone who chooses to do so will be fully supported by all at Ark and Dove. Masks can be provided for children and adults if needed.

YES

3. 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 COVID-19 and other infectious diseases, as specified in the Center for Disease Control current guidelines. People who have symptoms of respiratory or gastrointestinal infections, such as cough, fever, sore throat, vomiting, or diarrhea, should stay home. Children and adults will be asked to wear a mask if they present with possible Covid symptoms during a LOGOS event and are encouraged to get tested afterwards. Cleaning and hand washing will also be mandatory for all participants prior to eating. I 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

Payment: To help defray the cost of family meals (5 per calendar year), snacks, and crafts

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

LOGOS Registration 2024-2025

Description

Please Fix the Following