Grade for 2011/2012 School Year: K 1St 2Nd 3Rd 4Th 5Th 6Th

Summer Soak Registration Summer Soak Registration Name ______Name ______Address ______Address ______City ______City ______State ______Zip______State ______Zip______Phone Number (_____) ______Phone Number (_____) ______Grade for 2011/2012 School Year: K 1st 2nd 3rd 4th 5th 6th Grade for 2011/2012 School Year: K 1st 2nd 3rd 4th 5th 6th Pre-School Age 3 4 5 Pre-School Age 3 4 5 Rate your child’s Perceived Athletic Skill Rate your child’s Perceived Athletic Skill (1 to 10, with 10 Being the Highest)______(1 to 10, with 10 Being the Highest)______Emergency Contact Person/Phone Number: Emergency Contact Person/Phone Number: ______Important Medical Information Important Medical Information ______

Release in Full of Claims Release in Full of Claims

In consideration of the Summer Soak fun on June 13, 20, and 27, we In consideration of the Summer Soak fun on June 13, 20, and 27, we hereby release and forever discharge Grace Community Church of hereby release and forever discharge Grace Community Church of Goshen, IN, employees of GCC, and volunteer staff, from any and all Goshen, IN, employees of GCC, and volunteer staff, from any and all actions, causes of actions, claims and demands from upon or by reason actions, causes of actions, claims and demands from upon or by reason of any damage, loss, or injury, which hereafter may be sustained by of any damage, loss, or injury, which hereafter may be sustained by ______in consequence of participation ______in consequence of participation in said activities. in said activities.

I understand that in the case of emergency every effort will be made to I understand that in the case of emergency every effort will be made to contact me, but should this be impossible, I give my consent to the contact me, but should this be impossible, I give my consent to the sponsors to utilize good judgment to secure proper medical treatment. I sponsors to utilize good judgment to secure proper medical treatment. I do hereby release the sponsors and church from liability in such do hereby release the sponsors and church from liability in such decisions should they occur. I understand that Grace Community’s decisions should they occur. I understand that Grace Community’s insurance covers my child with “Secondary” Insurance Coverage. I, the insurance covers my child with “Secondary” Insurance Coverage. I, the undersigned, shall assume liability for all emergency medical costs, undersigned, shall assume liability for all emergency medical costs, which are incurred. which are incurred.

Parent or Guardian Signature and phone number Date Parent or Guardian Signature and phone number Date

By registering your child, you give GCC permission to take photographs By registering your child, you give GCC permission to take photographs or video of your child, which may be used in a highlight video and future or video of your child, which may be used in a highlight video and future advertising for the event. advertising for the event.

Registration form due by Sunday, June 6 to guarantee a spot. Registration form due by Sunday, June 6 to guarantee a spot. Mail or deliver to: Grace Community Church 20076 CR 36 • Goshen, IN Mail or deliver to: Grace Community Church 20076 CR 36 • Goshen, IN 46526 46526 Mail or Deliver to: Grace Community Church 20076 CR 36 • Goshen, IN 46526 www.gracecommunity-church.com

Grace Community Church is bringing you Summer Soak—an event for kids Wednesday nights from 6:30 – 8:00 pm June 13th, 20th, & 27th Grace Community Church is bringing you Come and splash away the summer heat Summer Soak—an event for kids with crazy water competitions! Wednesday nights from 6:30 – 8:00 pm June 13th, 20th, & 27th Details:  Summer Soak is for Kindergarten through 6th Grade Come and splash away the summer heat  This event is totally FREE, but space is limited!  Check-In begins at 6:15pm. with crazy water competitions!  Space is limited; pre-register by June 6th.  Print registration from website and turn in at church. Details: th  574-533-7546 if you have questions.  Summer Soak is for Kindergarten through 6 Grade  Dress to get drenched, wear sandals or flip-flops,  This event is totally FREE, but space is limited! and bring a towel!  Check-In begins at 6:15pm. th  Fun activities for pre-schoolers (age 3-5) also  Space is limited; pre-register by June 6 . offered!  Print registration from website and turn in at church.  574-533-7546 if you have questions.  Dress to get drenched, wear sandals or flip-flops, and bring a towel!  Fun activities for pre-schoolers (age 3-5) also offered!

Mail or Deliver to: Grace Community Church 20076 CR 36 • Goshen, IN 46526 www.gracecommunity-church.com