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About
Get Involved
Connect
Grow
Serve
Volunteer
Kids & Youth
JarKids
>
About JarKids
Student Ministries
Give
Registration
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Indicates required field
Child's Name
*
First
Last
Child's Address
*
Last Grade Completed
*
Child's Age
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City
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Allergies
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Parent's Name
*
Parent Email
*
Parent Cell Phone
*
Parent Home Phone
*
Emergency Contact Phone
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Emergency Contact Name
*
List of people authorized to pick your child up
*
Waiver: I understand that The Jar Community Church will make every effort to contact me in the case of any emergency involving my child. I authorize an adult representative of The Jar Community Church, in whose care my child has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to my child under the general or special supervision of any licensed physician or licensed dentist. I shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. I hereby release The Jar Community Church, church employees, and volunteer staff of The Jar Community Church from any and all liability while my child attends and participates in activities sponsored by The Jar Community Church.
I authorize The Jar Community Church permission to use any photographs or video taken of me and/or my child(ren) in any and all publications and other media/mediums and for any other purpose and manner without restrictions, whether now known or hereafter existing.
Typing your name in the box below will act as your digital signature.
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