KBC 2024 Registration

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In an event of an emergency, our first priority is to call 911 and a parent/guardian.  The health information provided below will not be shared and will only be kept confidential and used for emergency purposes only. 
Choose the days that your child will participate at KBC.
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Please read the following agreement and sign below:

Zero Tolerance Consent*

In our church community, we uphold a strict policy of zero tolerance towards bullying, derogatory language, and any form of disrespectful behavior. We believe in fostering a safe and inclusive environment where everyone feels valued and respected. Together, we strive to create a culture of kindness, empathy, and mutual support, ensuring that every individual can thrive and reach their full potential.

I acknowledge and agree for my child to abide by the zero tolerance policy implemented. I understand that this policy prohibits any form of bullying, harassment, discrimination, derogatory language, or disrespectful behavior towards others within the church's premises or during any related activities.


I represent that I am the parent/legal guardian of the child listed here, who is under 18 years of age. I understand that every activity sponsored by Assyrian Evangelical Church is carefully planned and adequately supervised by mature adults. I acknowledge that even with the best planning and precaution, unforeseen events can occur. I assume full responsibility for my child’s participation in Assyrian Evangelical Church activities, whether such risks are known or unknown to me at this time, and understand that my child is responsible for applying all instruction and rules given to him/her for any activity or incidental activity. I assume personal responsibility for and herby release and agree to indemnify and hold harmless ASsyrian Evangelical  Church, its officers, directors, employees, agents and any parties volunteering on behalf of the church ("AEC") from all actions (including, but not limited to, personal injury, property damage, or wrongful death), costs, expenses or damages of any kind growing out of or related to any activities (on or off church grounds), transportation to and from activities, or for any liability for personal injury, property damage or wrongful death caused by or resulting from participation in such activities. I further hereby waive the provisions of Section 1542 of the Civil Code of the State of California, which provides: "A general release does not extend to claims which the creditor does not know or suspect exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor." This release shall be binding upon my heirs, representatives, successors and assigns.


I will assume full responsibility for any medical costs incurred in the event of an accident or other incident requiring medical treatment and I release Assyrian Evangelical Church from any liability for such costs. In the event of an emergency in which my student is in need of immediate hospitalization, medical attention or surgery, and after reasonable efforts have been made to contact me or my spouse and we cannot be located for the purpose of consenting thereto, I hereby consent and authorize medical treatment, including but not limited to, emergency surgery or treatment, which is deemed advisable or necessary by, and is to be rendered under the general or special supervision and upon the advice of a medical professional licensed under the provisions of the Medical Practice Act of the State of California.

I agree to pay any and all medical costs and other expenses associated with such treatment, including transportation costs. I understand that my medical insurance carrier may be billed for medical charges in the case of illness or injury while participating in any church sponsored activity on or off campus.

I fully understand that by signing this form I am releasing Assyrian Evangelical Church from certain forms of general and medical liability



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