CREW Registration Form 2024/25

CREW Registration Form 2024/25 Program Year
Student's Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender
Student's Cell Number (if seperate from parents)
Please enter a valid phone number.
Student's Email Address (if applicable)
example@example.com
T-Shirt Size
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School
Grade (2024/25 School Year)
Track (if applicable)
Parent/Guardian Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship
Medical Waiver & Release
Insurance Provider Name
Medical Insurance #
Does the child have any allergies?
Are there any special circumstances we should be aware of? (Medical, Behavioral, Academic, Family Concerns, Etc.)
Medical Waiver / Release is required for any on/off campus event, retreat, or activity when students are dropped off for activities without a parent/guardian present.

I hereby authorize the performance of any necessary emergency medical, dental, or surgical procedures under local and general anesthesia which may be advised by the attending physicians of my child while a patient of any US hospital. Furthermore, I respectfully request the use of any of the hospital’s services or facilities which may be regarded as necessary or beneficial in the performance of the said procedure. I agree to hold the hospital and doctors harmless from any liability in the treatment or admissions of my above-named child when practicing medicine according to current standards and knowledge. Let this be your authority to treat and admit my child until I arrive at your hospital and formally sign the necessary papers. It is understood that this authorization is given in advance of any specific diagnosis or emergency treatment being rendered.
Digital Signature for Medical Waiver & Release

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Acknowledgment
- If a chaperone or driver is needed, I'll do that.
- I will sign up for at least one meal to Feed the Crew.
- I allow my child to be photographed/recorded to be used for marketing, promotion, and advertisements of First United Methodist Church of Fuquay Varina.
- I allow Amy Lynn Clark (Director of Youth) to communicate with my child via text and/or email
- I allow my child to ride any vehicle that is related to the group's activities provided that there's an adult on board.
- I release this organization from any liability for accident or injury to my child during the organization-related events.
Parent/Guardian Signature

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Date Signed

MonthDayYear
Date
Should be Empty:

CREW Registration Form 2024/25 Program Year

Parent/Guardian Information

Medical Waiver & Release

Acknowledgment