If you have any questions please contact me! Pastor Donny

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1 When? November 4th and 5th Where? Peoples Church Salem, OR How much? $40 before October 13th $50 after October 13th I am so excited to go to Kids Convention with your kids! This is such a great event! They will worship, play, learn about how awesome the God we serve is and so much more! We will be staying at Peoples Church over night. If you have any questions please contact me! Pastor Donny

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3 >>>>>>>> GIVE THIS SECTION TO YOUR KIDS LEADER >>> DO NOT SUBMIT TO THE OMN OFFICE >>> MUST REGISTER WITH A GROUP Note: This form does not substitute for a parent authorization form / Permission Slip. Please see your Youth Leader for that. KIDS NAME: GENDER: PARENT NAME: PHONE: I m coming to KC16! I m getting a KIDS size T-shirt! Only available if ordered before the early deadline, Oct 13 (circle one) XS S M L XL I m getting an ADULT size T-shirt! Only available if ordered before the early deadline, Oct 13 (circle one) XS S M L XL 2XL 3XL 4XL $ is included with my registration in (circle one) CASH CHECK Make check payable to the group you re coming with. Do not bring individual funds or registration to event

4 NEXTGEN MINISTRIES OF NEW LIFE CHURCH 2016 Parental Consent, Certification and Medical Authorization Form Parents and legal guardians of minor children are asked to complete this form and return it to the church. The information requested is designed to assist the church in providing for the safety of minors during church-sponsored activities. General Information (please print) *ONE FORM PER STUDENT* Student s Name Date of Birth Grade Father s Name Child s Address Home Phone Parent s Cell Phone(s) Family Doctor Mother s Name Parent s Work Phone Dr. Phone Medical Insurance Provider Group # Policy # Name of Primary Insured Consent and Certification I, the undersigned, being the parent or legal guardian of the student named above, do hereby consent to the participation of my child in all of the regularly-scheduled activities of the youth ministry of New Life Church. This may include field trips, campouts, swimming, boating, hiking, sporting events, and any other activities customarily associated with a church youth group. Further, I certify that my child is physically fit and adequately trained to participate in such events, including swimming, (except as noted below). Medical Questionnaire Is your child presently being treated for an injury or sickness or taking any form of medication for any reason? Yes No (if yes, please explain) Is your child allergic to any type of medication? Yes No (if yes, please explain) Does your child require a special diet? Yes No (if yes, please explain) Does your child have (or has ever had) any of the following: (circle, and explain below) Seizure disorders Asthma Heart murmur Diabetes Hay Fever Kidney disease Does your child have any allergies other than medical? Yes No (if yes, please explain) Does your child ever sleep walk? Yes No Can your child swim? Yes No Does your child have any physical handicap or illness which would prevent him/her from participating in normal rigorous activity? Yes No (if yes, please explain) Medical Treatment Authorization I understand that I will be notified in the case of a medical emergency involving my child. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. I authorize the New Life Church Staff to make emergency medical care decisions on behalf of my child, if required by law or a health care provider I understand that the church will not be responsible for medical expenses incurred solely on the basis of this authorization. I agree to notify the church in the event of any health changes which would restrict my child s participation in any normal youth or children s activities. I also understand that the adult supervisors reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child. (Signature of Parent/Guardian) (Date)

5 KC16 Permission Slip: I give my child permission to attend The Kids Convention 2016 with Pastor Donny and Jennifer Waite, Youth Pastors of New Life Church ( th st Springfield, OR). In the event of a medical emergency I give Pastor Donny and Jennifer Waite permission to authorize medical treatment. While there is always adequate adult supervision, I understand that my child is responsible for his/her behavior, attitude and safety. I do not hold New Life Church, the board members of New Life Church, congregation, or kids staff (volunteer and paid) liable in the event of an accident, emergency or behavior problem. If my child is uncontrollable, dangerous, has a bad attitude or needs extraordinary discipline I understand that I will be responsible to immediately come pick them up from Peoples Church in Salem, OR (Parent Signature) (Date) The phone number I can be reached at during this event: Photo release/permission to use pictures for promotional purposes: The undersigned parent(s) or legal guardian(s) of my child in consideration of the benefits of the child participating in the activities of New Life Church, hereby grants New Life Church the right to photograph said child, and to use said photographs, regardless of the form thereof, which may included but not necessarily be limited to still format, digital format still or digital format video, to promote New Life Church youth or children s ministry. It is understood and agreed that the photographic images taken by New Life Church or used by New Life Church for promotional purposes may be used in various forms, including but not necessarily limited to printed forms, transmission via internet, television or otherwise. The permission herein granted shall continue in effect unless revoked in writing. (Parent Signature) (Date)