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Truth Trackers Registration & Medical Release Form
Name
(
Required
)
Email Address
(
Required
)
Child's Information
Child's Name
Age
Birthday
January
February
March
April
May
June
July
August
September
October
November
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Address
|
Allergies or Medical Info
Parent's Information
Parent/Guardian Phone Number (
Required
)
Emergency Contact (
Required
)
In the event of an emergency, who do we contact? Phone number?
Authorized Pick Up Person #1 (
Required
)
Please let us know the primary person who is allowed to pick up your child from Truth Trackers.
Authorized Pick Up Person #2
[Optional] Please let us know the secondary person who is allowed to pick up your child from Truth Trackers.
Authorized Pick Up Person #3
[Optional] Please let us know a third person who is allowed to pick up your child from Truth Trackers.
Liability waiver (
Required
)
As a parent or guardian, I do herewith authorize the treatment by a qualified and licensed medical doctor of the above named minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. This blanket permit will cover any and all outings and events my child will attend within TRUTH TRACKERS during the 2025-2026 club year. This release will be in effect starting September 3, 2025, and continue until June 3, 2026. Answering "yes" also serves to indicate willingness to take full medical insurance responsibilities for my son or daughter and to release Lighthouse Baptist Church from this liability.
Yes
No
Solve 9 + 7 = ?
Submit