2025 Activity Waiver

Please complete the following to participate in The Oklahoma Assembly of the Church of God events.

Your name *

Email address *

Household members

Address

Permissions

I hereby grant permission for my child to participate in the activities and events of the Oklahoma Assembly of the Church of God (OKCHOG) Ministries. I understand that I and/or my children/wards participate in these activities at their own risk and that OKCHOG staff and its volunteers are not liable for any personal or otherwise injury to or caused by myself and/or the minor(s) listed. Should any problems arise concerning the behavior of my child that would require them to return home before the end of the activity and/or event, I will orchestrate and pay for their return home in the specified time frame.

I recognize OKCHOG and permit them to use all photos and video images taken at any activities or events in their publicity materials, such as but not limited to their website, bulletin board, newsletter, etc. I grant permission for images of my child to be taken and used for such purposes.

I authorize the treatment of the minor(s) listed by a qualified and licensed medical doctor in the event of any medical emergency. I permit those in charge to obtain any medical care they feel necessary for my child. I understand that as a parent or guardian, I will be held responsible for paying for any such medical expenses.

Sign Here *

I Agree to the above and adopt this digital signature as my own.

Emergency Contact 1

Name *

Emergency Contact 2

Name

Medical Information

Medical Insurance Company

Policy Number

Primary Care Physician

Primary Care Physician Phone Number