GEMS Registration

GEMS Registration

We are so excited that your child is interested in joining or rejoining Gems this year! Please fill this form out to the best of your ability and if you have any questions do not hesitate to reach out to Darcey Lomax-Cobbs at darceylynn10@gmail.com.
CHILD INFORMATION:
Child Name:*

First NameLast Name
Grade:*
Birthdate:*

MonthDayYear
Child Name:

First NameLast Name
Grade:
Birthdate:

MonthDayYear
Child Name:

First NameLast Name
Grade:
Birthdate:

MonthDayYear
GEMS T-shirt/Uniform Size:

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult Large
School Name:
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:*

Area CodePhone Number
Cell Phone:*

Area CodePhone Number
E-mail: (for reminders & newsletters)*
Church Name:
Type a question

I give permission for my child's photo/video to be taken and used for GEMS media and promotions of the club and for her first name only to be used in identifying her.I give permission for my child's GEMS leader to contact my child via email.
Child's Email Address:
example@example.com
Consent

By checking the above boxes, I hereby release the above name GEMS Girls' Club from all claims and liabilities arising out of the use of these photos and videos and transportation from the club's location. I also understand that this consent will remain in effect until a written request to revoke consent is received by the club.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

GEMS Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

Consent