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(Please provide details of the primary contact person first)

Include any medical conditions (MC), allergies (AG), medication or custody orders (CO).

Please add all additional members of your household.
Include in Medical Notes any medical conditions (MC), allergies (AG), medication or custody orders (CO).

Consents

Media Consent

From time to time LifeHouse may take photographs and/or videos at church programs and events for the purpose of archiving and for promotional use on our website, social media, etc. If you desire to opt-out of having your child(ren)'s image and/or video used, please complete this form: optout.life.house

The data collected on this form by LifeHouse International will be stored safely within Planning Center Online servers. It can only be accessed by authorised Staff and Department leaders and is used for the purpose of caring for and communicating with you and your family, in particular, in the case of an emergency and will not be disclosed to any other parties other than by legal obligation.

By selecting Yes, you agree to us storing your information in our system.

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