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Purpose & Mission
Pastor Bhen Andaya
The Gideons International
Operation Christmas Child
House Church Ministries 2019 VBS Registration Form
Grade (In September 2019)
What church (if nay) do you attend?
How did you hear about VBS?
Did anyone invite you to VBS?
No my child does not have any medical/allergy concerns
Yes my child does have medical/allergy concerns
If answered "yes" to medical/allergy concerns please explain here
House Church Ministries Release & Arbitration Agreement In case of an emergency in which my child needs immediate medical attention or surgery and after reasonable efforts have been made to contact me or my emergency contact and we cannot be located I hereby give permission to the physician selected by the adult leader in charge to secure proper treatment including hospitalization anaesthesia surgery or injections of medication to my child. In consideration of House Church Ministries and other organization I for myself forever wave release and discharge House Church Ministries and all other organizations from any/all injuries claims disputes liabilities or actions resulting from House Church Ministries and other organizations providing services for me or my family or for our benefit regardless of location for the date identified above Except for injury or damage arising out of House Church Ministries and other organization negligence or wilful misconduct. I attest and verify that I have full knowledge of the risks and dangers involved that I assume such risks and that I will assume and pay my own medical and emergency expenses in the event of an accident illness or other incapacity regardless of whether I have authorized such expenses. Any controversy arising out of connected to or relating to any matters herein of the transactions between me and the above-mentioned parties or on behalf of the minor child named below of this Release/Wavier or the breach thereof including but not limited to any claims of violation of Federal and/or State Law as well as any common-law claims shall be settled by arbitration and in accordance with this paragraph a judgment based upon the arbitrator's award may be entered in any court having jurisdiction thereof in accordance with provisions of R.C.W. 7.04. This agreement shall be construed and interpreted under the laws of the State of Washington. I HAVE READ THIS WAVIER AND RELEASE CAREFULLY AND UNDERSTAND IT. BY COMPLETING AND SUBMITTING THIS FORM I GIVE PERMISSION FOR MY CHILD/YOUTH TO PARTICIPATE IN THE ACTIVITIES ASSOCIATED WITH THIS EVENT FROM JULY 15 TO JULY 19 2019.
I grant permission for House Church Ministries to use photos pictures videos and audio recordings of my child for any purpose consistent with the mission of the church. These may include but are not limited to social media bulletins flyers and promotional materials. I acknowledge that said minor will not receive any compensation for the use of such pictures or videos and hereby release House Church Ministries and its agents from any and all claims which arise out of or are in any way connected with such use
I have read and understood this consent and release.
I give my consent to House Church Ministries for the aforementioned purposes.
I DO NOT give my consent to House Church Ministries for the aforementioned purposes.
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House Church Ministries
1412 W. Central Ave., Spokane, WA 99205
PH: (509) 270-8252
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