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DOVE Water Balloon Battle - August 15, 2018
Parent/Guardian Name:
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Child's Name :
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Date:
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Emergency Contact Number
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By checking this box, I certify that I am the parent or legal guardian of the listed child(ren). I hereby release and agree to hold harmless DOVE Westgate Church and all representatives thereof from any and all liability, claims, and demands for injury, sickness, or death which may be incurred by my child(ren) in the course of participation of the DOVE Water Balloon Battle on August 15, 2018. I give authorization for the church to obtain medical treatment if necessary. I also give permission for pictures to be taken during the Water Balloon Battle for the sole purpose of future promotions at DOVE Westgate Church. Additionally, DOVE Westgate Church requires compliance with all rules and regulations set forth by the leadership of ELEVATE Youth, including those regarding conduct, dress and Christian lifestyle and strict adherence will be expected. Failure to do so could result in my child's dismissal from the event, upon which I will be expected to provide immediate retrieval of the child from the event. By checking this box I am indicating my agreement all of the above.
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Physician's Name and Phone:
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Insurance Company:
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Policy Holder and Number:
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Parent/Guardian signature:
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