Student Ministries Registration Form

Trinity Student Ministries Registration
Registration fees

Girl's Ministries: $30/person
Royal Rangers: $20/person
Ministry*
Parent’s Name*

First NameLast Name
Child’s Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Child's Age*
Child's Grade*
Child's Grade*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Phone Number*
Allergies*
T-Shirt Size
T-Shirt Size*
Photo of student*

Cancelof
Medical Treatment Authorization
Minor's Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Gender*
Medical Condition(s) for which the minor is receiving treatment: *
Prescription Drugs the minor is taking:*
Other pertinent medical information*
AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GAURDIAN(S) As custodian of the aforementioned minor, I grant my authorization and consent for a designated adult to administer general first aid treatment for minor injuries or illnesses. If the injury or illness is severe, I authorize him or her to seek professional emergency personnel to attend, transport, and treat the minor and to issue consent for any medical care deemed advisable by a licensed medical professional or institution. I authorize the designated adult to exercise best judgement upon the advice of medical or emergency personnel.
Effective Date*

MonthDayYear
Date
Date if Signature*

MonthDayYear
Date
Parent Signature*

Clear
Parent printed name*

First NameLast Name
Should be Empty:

Trinity Student Ministries Registration

Medical Treatment Authorization