2021-22 Ignite (Middle School) Registration

2021-22 Ignite (Middle School) Registration

Thursday night youth group / 6-7:30pm
Student's Name

First Name Last Name
Student's Birthday

Month Day Year
Date
Student's Grade

6th 7th 8th
Student's School
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student's Phone Number

Area Code Phone Number
Student's Email
example@example.com
Student's Mother

First Name Last Name
Mother's Email
example@example.com
Mother's Phone

Area Code Phone Number
Student's Father

First Name Last Name
Father's Email
example@example.com
Father's Phone

Area Code Phone Number
Emergency Contact (if unable to reach parents)

First Name Last Name
Area Code Phone Number
Any Health Concerns or Allergies we should be aware of?
Anything else we should be aware of when working with your student?
Tower Hill Church Media Release Form On behalf of myself and my minor children, I grant Tower Hill Church and its affiliated entities(collectively referred to as “Tower Hill Church”) full rights to use the images resulting from photography/video filming/sound recording at its Next Gen programs. Tower Hill Church has my permission to use my and my child’s image, photograph, video, audio or other digital media publicly. I understand that the images and recording may be used in online publications, print publications, presentations, websites, and social media. I understand and agree that all images of me and my children will become the property of Tower Hill Church. I also understand that no royalty, fee or other compensation shall become payable to me or my child by reason of such use. In addition, I release and relieve Tower Hill Church and its board of trustees/directors, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material.

Yes No
By registering your student, you are acknowledging that an inherent risk of exposure to COVID-19 exists in any public place where people are present. By attending, you and any guests voluntarily assume all risks related to exposure to COVID-19 and agree not to hold the First Presbyterian Church at Red Bank, its trustees, officers, employees, agents, contractors, or volunteers liable for any illness or injury.
I, parent name, as the parent of student's name agree to the guidelines set forth by Tower Hill NextGen.
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