Complete this section ONLY if you are the primary contact for the child but not the parent/legal guardian (grandparent, caretaker, babysitter, etc.) Please also complete the Parent Information.

I hereby give permission for this child to participate in events and activities hosted by Living Word Christian Church and receive oversight from the authorized staff in charge, whose care the child has been entrusted into while attending and participating in these events and activities. (Note that all staff must be a member of Living Word Christian Church and must comply with a background check and any/all restrictions thereof.)

I hereby give permission to Living Word Christian Church for this child to be offered snacks by authorized staff while in attendance. (Note that all Children’s Ministry classes are nut-free.)

I hereby give permission to Living Word Christian Church to record pictures or videos of this child while in attendance. I give permission to Living Word Christian Church to use these pictures of videos in church publications including, but not limited to, print publications, slideshows, church website, church social networks, etc. knowing that the child’s identity is kept anonymous.

I hereby give permission to Living Word Christian Church for this child to ride in a vehicle designated by authorized staff, for the purpose of transportation to and from events and activities hosted by Living Word Christian Church. (Note that all drivers must be at least 21 years of age and produce a valid driver’s license and proof of insurance.) This permission does not include personal transportation, only that as part of the activity.

If emergency or required medical care is needed, I hereby give permission to Living Word Christian Church to such medical care as deemed necessary by medical care providers or the authorized staff.

Please note all applicable allergies, medical conditions, mental conditions, health history, or medication information that would be necessary in an emergency: