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Cornerstone Kidz Childrens Ministry
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In order for my child to participate in activities sponsored by Cornerstone Church of God, I understand that I will be responsible for any medical expenses for myself and my dependents, if any, and to waive any legal right or claim against Cornerstone Church of God, its staff, members or directors that I might have as a result of injury incurred by participation in any such activity or travel to and from any such activity.

I understand and acknowledge that by signing this form I am authorizing any staff member, if in their sole discretion it is necessary, to administer first aid, contact a physician for medical treatment, summons emergency medical care, and/or to transport me/my dependent to a medical facility for treatment.

Participant (Please Print)
Parent or Guardian Signature
Phone: Home                     Work or Cell