Anchor Crew at Northwest Community Church 2025-26 Registration Form

Child's Name*

First NameLast Name

Gender*

Birth Date

MonthDayYear

Grade in school (Fall 2025)*

Do you have a church you attend? If so, please let us know what church your family attends.

For t-shirts, please only order one if your child doesn't have one or has outgrown theirs.

T-Shirt Size *

Email Address*

Phone # where you can be reached from 2:00- 5:30pm*

Area CodePhone Number

Mom

First NameLast Name

Dad

First NameLast Name

Does your child need transportation from Westfall School to the church?

Please list any allergies, medical conditions or other information we should be aware of

PLEASE READ (and digitally sign below)

PARTICIPATION AGREEMENT FOR ANCHOR CREW

I acknowledge that participation in Anchor Crew at Northwest Community Church involves risk to my child, and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in Anchor Crew, I, as the parent, acknowledge and accept the risk of injury associated with participation in Anchor Crew. I accept personal financial responsibility for any injury or other loss sustained during Anchor Crew or during transportation from Westfall Elementary to Northwest Community Church.

Further, I release and promise to indemnify, defend, and hold harmless Northwest Community Church for any injury arising directly or indirectly out of participation in Anchor Crew or transportation to the church.

DIGITAL SIGNATURE (typing your name in this box indicates your acknowledgement of the above authorization & consent)*

First NameLast Name

PLEASE INDICATE TODAY'S DATE*

Date

AUTHORIZATION & CONSENT FOR USE OF PHOTOS

I authorize and consent to the use of images or videos of my child listed above, with or without their name, by Northwest Community Church of Malcolm, Nebraska for purposes including but not limited to: promotional materials, printed publications, internet posts including social media, and other media sources.

I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release Northwest Community Church, its officers, trustees, employees, and agents from liability for any claims by me or any third party in connection with the use of the image of my child listed above.

DO YOU AUTHORIZE THE USE OF PHOTOS AS DESCRIBE IN THE SECTION ABOVE?*

YES, I authorize the use of photos of my child listed aboveNO, I do NOT authorize use of photos of my child listed above

PLEASE INDICATE TODAY'S DATE*

Date

DIGITAL SIGNATURE (typing your name in this box indicates your acknowledgement of the above authorization & consent)*

First NameLast Name

Northwest Community Church - Anchor Crew Fall 2025 Registration Form