• The Brigade Youth Program Brockton

    Registration Form
  • Child's Information

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    Pick a Date
  • Parent/Guardian Information

  • Spiritual Status

    While church membership is NOT required, we are interested in knowing if your family is a member of a worshipping congregation.
  • Emergency Contacts / Medical Information

  •  - -
    Pick a Date
  • Emergency Contact

    who can we contact in an emergency or nonemergency if you can not be reached. Please note that the person listed as "emergency contact" is automatically authorized to pickup your child from the program.
  • Child's Medical Information

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  • Child's Insurance Information

  • Required Parent/Guardian Signature

  • General Permission

    I GIVE MY CHILD PERMISSION TO PARTICIPATE IN THE BBGB PROGRAM. I UNDERSTAND THAT THIS INCLUDES CLOSELY SUPERVISED OUTDOOR ACTIVITIES AND FIELD TRIPS. I HAVE SUBMITTED ALL PERTINENT INFORMATION FOR MY CHILD TO THE DIRECTOR OF THE PROGRAM. I DO NOT HOLD BBGB, GRACE CHAPEL BROCKTON OR ANY OF THEIR AFFILIATES LIABLE FOR ANY PERSONAL INJURIES THAT MAY OCCUR TO MY CHILD DURING THEIR PARTICIPATION IN THE PROGRAM. I GIVE PERMISSION TO THE HEALTH CARE PROFESSIONAL SELECTED BY BBGB TO ORDER ANY TREATMENTS RELATED TO THE HEALTH OF MY CHILD FOR BOTH ROUTINE HEALTH CARE AND IN EMERGENCY SITUATIONS. IF I CANNOT BE REACHED IN AN EMERGENCY, I GIVE MY PERMISSION TO THE HEALTH CARE PROFESSIONAL TO HOSPITALIZE, SECURE PROPER TREATMENT FOR, AND ORDER INJECTION, ANESTHESIA, OR SURGERY FOR THIS CHILD. I UNDERSTAND MY CHILD’S HEALTH INFORMATION WILL BE SHARED ON A “NEED TO KNOW” BASIS WITH BBGB STAFF.
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  • Photo/Video Release

    I GIVE PERMISSION FOR THE IMAGE OF MY CHILD, TO B USED ON THE BBGB WEBSITE, IN OTHER PROMOTIONAL MATERIALS OF THE CHURCH OR THE EPISCOPAL DIOCESE OR OTHER PARTNER ORGANIZATIONS.
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  • Field Trip Permission

    I GIVE PERMISSION FOR MY CHILD, TO PARTICIPATE IN ALL BGBB FIELD TRIPS
    (INCLUDING BUS TRIPS). IT IS IMPORTANT FOR YOUR CHILD TO FOLLOW ALL
    PROGRAMS AND GROUP RULES. OTHERWISE, YOUR CHILD MAY LOSE ALL FIELD
    TRIP PRIVILEGES.
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      Registration FeePlease let us no if you need help with payments.
      $50.00
        
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