Family Name
Primary Contact*
First
Last
Email*
Address*
How many people will be attending in-person on March 7?*
I confirm that all members of my family will not have traveled to a restricted state within 14 days prior to attending the event. A list of states can be found at www.chicago.gov/city/en/sites/covid-19/home/emergency-travel-order.html* I agree that all members of my household will abide by any health guidelines for wearing a mask and maintaining social distance while at the events, where applicable.* I agree that members of my household will not attend the event if they are experiencing any symptoms of sickness (fever, cough, shortness of breath).* Acknowledgement of Responsibility* By attending The Moody Church’s ministry activities, you acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you and your family members may be exposed to, including infection by COVID-19. You also acknowledge that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of yourself and/or others, including, but not limited to, The Moody Church’s employees, contractors, volunteers, and participants. You agree to assume all the foregoing risks, waive liability against The Moody Church and any other listed parties, and accept sole responsibility for any illness, injury, disability, or death, including all claims that may arise resulting from any of these.
Will you be registering children for TMC Kids childcare? If Yes, please fill out the TMC Kids registration information below.
Parent/Guardian(s) Name(s)
First
Last
Primary Phone*
Alternate Phone
Are both parents living at home?* Yes No
If No, who has legal custody of the child?
If the person who regularly brings the child to church is different than above, please list:
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age* Grade Entering Spring 2021:* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Emergency Contact Name*
First
Last
Emergency Contact Relationship to Child*
Emergency Contact Phone*
Parent(s) typical location during church time or other ministry:*
Family Doctor
Doctor Phone
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe*
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in TMC Kids programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2020/2021 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register A 2nd Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2020/2021 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 3rd Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2020/2021 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 4th Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2020/2021 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 5th Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2020/2021 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 6th Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2020/2021 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 7th Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2020/2021 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
