CPC 23-24 Children's Ministry Registration Form

Colbert Presbyterian Church 2023-2024 Children's Ministry Registration Form

Please complete one form for each child participating in children's ministry.
Child Name*

First NameLast Name
Child Birthday*

MonthDayYear
Date
Child Current Grade*
Child School
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Additional Information (allergies/special concerns/comments) - if none, type N/A*
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
PERMISSION
My student has my permission as her/his parent or legal guardian to participate in any and all events and activities sponsored or endorsed by Colbert Presbyterian Church during the next twelve months.

I acknowledge that by participating in church-sponsored events, my child may be involved in activities occurring both on and off church property, during both day and evening hours. I further acknowledge that by participating in church-sponsored events, my child may be involved in recreation and sporting activities.

In recognition of these risks and realities in consideration of my child being offered the opportunity to participate in and benefit from these church-sponsored events, I agree on behalf of myself and my child to release, waive and disclaim any and all liabilities of or claims against Colbert Presbyterian Church.

I further idemnify Colbert Presbyterian Church for any and all damage or injury my child may cause to others as a result of his/her participation in the church-sponsored events. I further understand that it is my responsibility to keep current the information contained on all records held in the church office including, but not limited to, my address, phone, emergency contact, and insurance information.
Video/Photo Release
Unless I have indicated otherwise below, I understand that pictures, video, recordings, and/or audio recordings of my child may be displayed in brochures, newsletters, video productions and/or other electronic media designed and distributed to inform the congregation and/or general public of programs and events taking place in the church. I understand that my child will not be identified by name without my express written permission.
Yes, I give my consent.No, I do NOT give my consent.
Medical Release
In the event my student requires medical attention and I cannot be reached immediately, I give permission for Colbert Presbyterian Church staff, volunteers, teachers, or youth/children directors to authorize medical attention.
Parent/Guardian Electronic Signature*
Date*

MonthDayYear
Date
Should be Empty:

Colbert Presbyterian Church 2023-2024 Children's Ministry Registration Form

PERMISSION

Video/Photo Release

Medical Release