Request For Information (Rfi) Family Form
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FAMILY FORM
Please Print
Household Last Name:
____ ___
_
First Name: ______
________________
Are you the Main Household Contact: __YES ___NO If NO, who is?:_______________________________________
*THE INFORMATION CONTAINED ON THIS FORM IS USED TO REGISTER YOUR FAMILY FOR MGA ACITIVES*
Address: _______________________________
Postal Code:____________________
Private
Phone (Home):__________________________
Cell: __________________________
Private
Email: ________________________________
Nationality: ____________________
Private
Family Emergency Contact Name:__________________________ Relation to Family:_______________
Emergency Contact Phone #: _______________________
Private
* I/We want to be included in the MGA Family Directory: Yes No (please check ONE box)
** Please check “PRIVATE” beside any information you do NOT want to appear in the MGA Family Directory **
**Parent/Guardian Consent for Children (Ages 0-18)**
Are you the Legal Parent/Guardian of this child/ren? Yes No - if NO, then who is?
Parent/Guardian Contact Phone #’s:
Private
I/We give consent for my/our child/ren to attend FAMILY events being sponsored by McMurray Gospel Assembly.
In the event that he/she is injured while under the care of McMurray Gospel Assembly and its representatives and requires the
attention of a doctor, I/we hereby consent to and will be responsible for any reasonable medical treatment as deemed necessary by
a licensed physician.
I/We further agree to hold the McMurray Gospel Assembly and its representatives free and harmless of any claims, demands or
suits for damages arising from the authorization and provision of such medical treatment.
I/We understand the nature of the event/s and do hereby release McMurray Gospel Assembly and its representatives from any
liability due to accident or injury incurred by my/our child/ren.
I/We agree to cover all costs if my/our child/ren needs to be sent home for disciplinary reasons.
I/We give permission to publish photographs and video of my/our child/ren to promote MGA Family ministries.
I/We understand that this form gives consent for my/our child/ren to attend all future MGA events, and that it is
my/our responsibility to contact MGA should I/we have questions regarding said events, and/or if I/we choose to
withdraw our consent.
Legal Parent/Guardian Signature
Adult #1 – Personal Information
Title (Pastor, Dr., Mr., Mrs., Ms.):
____
Marital Status:
First Name:
Wedding Anniversary:
Last Name:________________________
Water Baptism Date:
Gender:
Male Female
Holy Spirit Baptism Date:
(Please Circle ONE)
Date of Birth:
Adult #2 – Personal Information
Title (Pastor, Dr., Mr., Mrs., Ms.):
____
Marital Status:
First Name:
Wedding Anniversary:
Last Name:________________________
Water Baptism Date:
Gender:
Male Female
Holy Spirit Baptism Date:
(Please Circle ONE)
Date of Birth:
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