SuperStart! Registration
Please select your registration(s):
I am registering my child to attend SuperStart
I am registering myself to attend as a chaperone
Chaperone Name
First Name
Last Name
Chaperone's Gender
Male
Female
Chaperone's Date of Birth
Chaperone Email
example@example.com
Chaperone Phone Number
Please enter a valid phone number.
Chaperone Home Church
Please list city and not just "Church of the Nazarene"
Parent Name
First Name
Last Name
Parent Email
example@example.com
Parent Phone Number
Please enter a valid phone number.
Student Name
First Name
Last Name
Student's Gender
Male
Female
Student's Current Grade
Please Select
4th Grade
5th Grade
6th Grade
Student's Home Church
Please include the name of the city the church is in
Minor Participation Authorization and Consent to Emergency Medical Treatment
I hereby give my consent to have my minor child participate in the following activity, SuperStart, (hereafter “the activity”) on March 6-7, 2026. I recognize that there are risks involved in participating in this activity and hereby assume all risk or injury, harm, damage, or death to my minor child in connection with his/her participation in this activity. To the fullest extent permitted by law, I release: the (Church) Chicago Central District and, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless: the (Church) Chicago Central District and, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child’s participation in the activity. Further, being the parent or legal guardian of the minor child, I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child. I understand that efforts will be made to contact me prior to treatment but, in the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. As parent of legal guardian, I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child. Any insurance policy of the church or organization sponsoring this event will be used as the secondary coverage.
Chaperone Participation Authorization and Consent to Emergency Medical Treatment
I hereby agree to participate in the following activity, SuperStart, (hereafter “the activity”) on March 6-7, 2026. I recognize that there are risks involved in participating in this activity and hereby assume all risk or injury, harm, damage, or death in connection with my participation in this activity. To the fullest extent permitted by law, I release: the (Church) Chicago Central District and, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to myself while participating in the activity and agree to save and hold harmless: the (Church) Chicago Central District and, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my participation in the activity. Further, I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for me. I understand that efforts will be made to contact my emergency contact prior to treatment but, in the event he or she cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat myself. I understand that I am responsible for the health care decisions of myself and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given. Any insurance policy of the church or organization sponsoring this event will be used as the secondary coverage.
Submit
Should be Empty: