Student Info/Activities Form
Please fill out this form and click submit.
Student Name
*
Parent/Guardian Name
*
Parent/Guardian Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
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OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
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VT
WA
WI
WV
WY
YT
By checking the box below, I agree to the following:Permission and Medical Release: I, the parent or guardian, grant my permission for him/her to participate fully in all YOUTH program activities, events, and trips sponsored by Saint Michael Community Church. In the event treatment is called for in which a physician (or hospital personnel) is needed, I authorize adult leaders, volunteer or paid, to give such consent for all necessary medical treatment if we cannot be reached or if because of an emergency. Should medical help be needed, I agree to pay either directly and/ or through my own health insurance policy all medical or hospital costs and to be solely responsible for said treatment and the cost thereof. I will keep my contact information up to date in charms so I may be contacted as needed. Waiver of Liability: I, the parent or guardian, in consideration of my youth being allowed to participate in all YOUTH activities, events, and trips, being the undersigned, intending to be legally bound, hereby waive and release all rights and claims for damages, for injury, accident, or liability of any kind which I might have against Saint Michael Community Church, church staff, volunteer leaders and other participants. I acknowledge that my youth will participate at his/her own risk. Photo Disclaimer: I, the parent or guardian, understand my youth will be involved in YOUTH program activities, events and trips and give permission for my youth’s photo or video to be placed on the website, in newspapers, publications, or in other promotional materials. I agree that my child will adhere to rules and conduct on activities by showing respect for people and property. No violence, alcohol/drugs/weapons/tobacco are permitted. Modest and appropriate clothing must be worn. I understand that failure to comply with these expectations could result in my youth being unable to participate in these activities.
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Please select all that apply.
I give permission for my youth to participate in activities and events.
By typing my full name and the date, I submit this as my "digital signature" approving the actions above.
*
I give permission for photos to be taken of my youth and to be used as property of Saint Michael Community Church.
*
Please select all that apply.
Yes, photos of my youth may be taken.
No, photos of my youth may not be taken.
Student Birthdate
*
Student Current Grade
*
As parent/guardian, I am interested in:
*
Please select all that apply.
driving students to an event/outing/trip
providing snacks/food for meetings
volunteering when needed
Submit
Description
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