Student Enrollment

2022 - 2023 Salem Student Enrollment

Today's Date

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Month *

Day *

Year *

Parent / Guardian #1 (Required)

Parent / Guardian Name *

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Last

Address *

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Line 2

City

State

Zip Code

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Phone Number *

Email *

Parent / Guardian #2 (optional)

Name *

First

Last

Address *

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Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Release of Liability

Please CHECK all four boxes below to advance. *

I understand that my child(ren) may be involved in physical activity as those in "Game Time" (defined below). As with any activity, there is a risk of injury. I fully accept this risk and hold harmless against any legal liability Salem Baptist Church and any persons involved in ministry at Salem Baptist Church. In the event that an emergency requires medical treatment for the above named child(ren), I understand every effort will be made to contact me or my emergency contact(s). However, if I/we cannot be reached, I give permission for Salem Baptist Church volunteers to secure the services of emergency medical help necessary for my child(ren)’s well being. I assume all responsibility for the costs of any accident and any treatment. I give permission for photos of my child(ren) to appear in an unpublished Children’s ministry directory to be used by volunteers only. I also give permission for photos/videos of my child(ren) to appear among general Children’s Ministry media for promotion as long as there is no identifying information shown. I give permission for my child(ren) to be transported by Salem Baptist Church. This box checked serves as a personal signature of honesty that represents the respective information on this form and the integrity of information for each student that will be completed for the remainder of this form.

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2022 - 2023 Salem Student Enrollment

Today's Date

Parent / Guardian #1 (Required)

Parent / Guardian #2 (optional)

Release of Liability

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