Brick Church -> Seventh/Eighth Grade Registration 2011-2012

Seventh/Eighth Grade Registration

The seventh/eighth grade ministry is a great group of students who meet for fun, fellowship, spiritual growth and service. Young adult volunteers and parents support and lead this ministry. To register for this year's seventh/eighth grade group, fill out this registration form and submit it to the church. All seventh and eighth graders must be registered to participate.

Student's Name

First*

Last*

Birthday and Grade*

School Name*

Parent/Guardian Name

First*

Last*

Primary Phone Number*

Alternate Phone Number*

Parent Email Address*

Emergency Contact Name*

Emergency Contact Number*

Permission Agreement

I,*

hereby grant my son/daughter*

a minor child, permission to participate in The Brick Church Youth Group. I will not hold The Brick Presbyterian Church, their staffs, Sessions, or the approved leaders or sponsors, liable for any accident or injury occurring during scheduled Youth Group events. I hereby grant permission to the adult supervisors and leaders of this group to make medical decisions with respect to said minor child in the event of an accident or injury when parental consent shall be unavailable or when circumstance

Signature

Enter initials to sign*

I agree to the following guidelines for community life:

Honor and respect the persons and property of those with whom we will be interacting;
Refrain from the use of tobacco, alcohol or other illegal drugs while attending this event;
Refrain from inappropriate sexual behavior;
Leave all radios, televisions, telephones, electronic games and devices at home;
Follow all rules as established by the leadership team.
Believing that I am part of a faithful community of the whole people of God, I promise to be responsible in my actions, abide by the community guidelines, be open in mind and spirit to the teachings and leadings of the Holy Spirit, and live in Christ’s love.

Participant Signature

Enter initials to sign*

Medical Information

Does your child have any allergies?

Yes No

If yes, please explain

Does your child take any medications?

Yes No

If yes, please list medications and conditions for which they are taken

Additional information about the participant’s medical history

Information regarding your medical insurance

Name of Insurance Company*

Policy Number*

Phone numbers for verification by emergency room staff

Expiration Date (if any)

Insurance Company Address

Street

City

State

Zip

Employer Name

Name of Policy Holder