Registration Form

REGISTRATION FORM

2025-2026 SCHOOL YEAR
School
Student Name

First NameLast Name
Grade
Student Cell Phone

Area CodePhone Number
Student E-Mail
example@example.com
Parent/Guardian Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-Mail*
example@example.com
Does the student have any food allergies, health needs, or medical issues? If so, list below:
Does the student attend a church? If so, where?
Any student may register for the School Ministries Program class regardless of race, religion, sex, age, national origin or handicap. All students must have parental permission to be escorted off school property and returned each period by our staff. We will carry the necessary insurance and will be legally responsible when students leave the school property. The program will be offered at no cost to students, and we are not affiliated with the school district.
Parent Permission for Participation
I request that the above mentioned child be released from school. I understand that they will be released during a related arts class period for the purpose of taking a Christian education class offered by the school ministries organization. I understand that the class will be offered during the school year and that I may withdraw my child at any point upon written notice, and likewise the program has the right to remove any student from the program for disciplinary issues or for being disruptive. Since my child is or has been involved in a school ministries program I realize that he/she and/or other members of my family may be identified, photographed, videotaped, and/or interviewed by or on behalf of this organization or the media at a School Ministry location or another place designated by them, and these items may be used by the media or submitted for the organization’s newsletter, as fundraising materials or other publications of the ministry. I grant School Ministries and the media permission to use pictures, videotapes and/or interviews of my child and other family members as needed for the purpose mentioned above. Note: We do not photograph those we serve against their will or permit any photograph that demeans or compromises their dignity.

***By signing this document, you are stating that you are the parent/legal guardian of the above mentioned child.
I wish for my child NOT to be photographed.
Signature

Clear
Date

MonthDayYear
Date
For more information, please contact Ailena Geddes, Director, at 864-921-7052.
Should be Empty:

REGISTRATION FORM

Emergency Contact

Parent Permission for Participation