PIONEER CLUB

 
 
 
 
 
Pioneer Clubs
PIONEER CLUB

WEDNESDAY . 6:30 -8:00 PM

Our Wednesday Evening  program for kids Kindergarten through 5th grade. This setting provides a safe educational time where kids will learn about the Bible and interact with other children. Parents can feel comfortable knowing their children will be taken care of by a well-trained staff.

Pioneer Club is offered Wednesday Nights, 6:30-8 PM, October 12th through March 22nd.

REGISTER YOUR CHILD NOW

Your Name (required)

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Do You Text (required)
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Your Street Address (required)

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Child 1 Name (required)

Child 1 Grade (required)

Child 1 Birthday (required)

Child 1 Allergies and Needs

Child 2 Name

Child 2 Grade

Child 2 Birthday

Child 2 Allergies and Needs

Child 3 Name

Child 3 Grade

Child 3 Birthday

Child 3 Allergies and Needs

In the course of the year we take photos and videos of our club members participating in activities. Do we have permission to photograph your child(ren)? (required)
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DON’T FORGET TO FILL OUT THE WAIVER FORM BELOW TOO!
WAIVER FORM
RISK ACKNOWLEDGEMENT AND RELEASE FORM FOR PARTICIPATION IN PIONEER CLUB AT NEW HORIZONS COMMUNITY CHURCH

Please read this agreement CAREFULLY before signing. If the participant is a minor (under the age of 18), all documents must also be signed by either a parent or legal guardian. All reference to “participant” deemed to include the parent or legal guardian of any participant who is a minor.

It is expressly understood and agreed that New Horizons Community Church (NHCC) shall not be responsible or legally liable for any losses of personal property or for any bodily injuries, or the results thereof, incurred and suffered by the applicant on any property of NHCC or in connection with any activities or programs, unless such loss or injury results directly from the negligent or willful act of an employee or ministry partner of NHCC acting within the scope of his or her employment.

The participant is aware in signing this form that certain elements of the program are physically and emotionally demanding, and that not all hazards and dangers associated with the activities can be foreseen. The participant understands that certain risks, dangers and injuries, including fatality, due to acts of God, inclement weather, slipping, falling, insect bites, equipment failure and all other circumstances that may exist in the programs activities. The participant also agrees it is impossible for NHCC to guarantee absolute safety.

The participant understands and voluntarily assumes all such risks, dangers and injuries associated with participation in this program and agrees that neither NHCC, its director, staff nor other representatives in any capacity shall be responsible for any loss, damages, or injuries resulting to the participant in the absence of gross negligence imputable to NHCC. The participant further agrees to release, indemnify and hold NHCC, its pastors, officers, staff and agents harmless from or for any claims, causes or action, liabilities or damages that may arise as a result of or in connection with his/her participation in the program.

The participant expressly agrees to obey all of the program safety regulations and direction by the program’s leaders. The participant voluntarily assumes and accepts responsibility for all risks, dangers and injuries resulting from either his/her failure to obey safety regulations and directions of activity leaders or from the exercise of judgment by such activity leaders made in good faith based on then existing circumstances.

The participant has read and understands the above form and understands the above Participant Agreement/Acknowledgment and Release Form. The participant’s signature(s) on this document is also intended to bind his/her/their successors, heirs, representatives, administrators and assigns.

I will assume the responsibility for restricting any activities agreed upon and listed above. I assume full responsibility for my health and I certify that I am free of or will notify my instructor of any medical, physical or emotional conditions which might create undue risk for myself or others. I will exercise good judgment in regard to my own health, safety and well-being while participating in the program. If for any reason I question my ability to participate in the activity, I will tell my instructor prior to participation. I hereby grant permission to the medical personnel selected by the pastors, program director, or other leadership staff to order x-rays, routine tests, hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for me. I also grant permission for medical personnel to obtain access to necessary medical, psychiatric or social work records.

I certify that photographs and videotape pictures of me participating in Pioneer Club activities may be used in promotional materials for the NHCC. I give my permission for NHCC to send me emails regarding upcoming events and news (we will not sell your information). This form may be photocopied for use out of NHCC.
 

Required Signature (required)

By signing, you are agreeing to all of the terms and conditions listed above.