Highland Community Church

Child's Name *

First Name

Last Name

Child's birthday *

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Name of Parent or Guardian *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone # for Parent or Guardian *

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Do you attend a local church?

Yes

No

I/we authorize Kingdom Sports or its designees to create, have, and use photographs, slides, and videos containing my child's image for its record-keeping or marketing/public relations programs. *

Yes, I agree to the use of content including my child.

No, please do not use content including my child.

By typing your name below, you are signing and consenting to the following: Being the parent/legal guardian, have been informed of the above activity provided by Kingdom Sports which is a ministry of Highland Community Church; at this moment give my consent for my minor child to participate in this activity and basketball related activity in 2025 that may proceed the league. I understand that the leaders of this activity will take all reasonable safety precautions and that the possibility of an unforeseen hazard does exist. Therefore, I further agree not to hold Kingdom Sports / Highland Community Church, and its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries by the minor listed on this form. I do consent to any medical treatment that may be deemed necessary for my minor child. Further, I understand that all efforts will be made to contact me before treatment. If I cannot be reached in an emergency, I permit the activity leader to make the decisions necessary for treatment. Should no activity leader be available, I authorize the attending physician to treat my minor child. I understand that the doctors, dentists, and other providers attending to my child will take all reasonable safety precautions during their care. *

First Name

Last Name

By checking "yes" you are acknowledging you have completed this registration using factual information and that you have read this form in its entirety. *

Yes

No

Date

Please list the date you signed this form.

MM

DD

YYYY