Junior Youth Challenge Registration Form-Digital Form v1

Parent/Guardian Information
Name

First NameLast Name
Parent/Guardian Address if different from student's

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Church Affliation

Permissions and Releases
OPTIONAL Photo and Video Release
Child Evangelism Fellowship® may, from time to time, document the activities of the ministry with photos or videos.

Yes, I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership, use and proceeds of all photographs or video of me or my minor student, without reservation or limitation, including use of photographs or video of me or my minor student for, but not limited to, advertising, educational, and promotional purposes.No, I do not grant permission to photograph or record me, or my minor student.
Signature
Date

MonthDayYear
Date
Permission to Leave Campus
I, the guardian of {nameOf}, do hereby give my permission for my student to leave school grounds with CEF approved workers for the purpose of attending Junior Youth Challenge. I release Child Evangelism Fellowship and the facilities used from liability for any injuries or sickness incurred as a result of my student’s participation in Junior Youth Challenge.
Signature
Date

MonthDayYear
Date
Should be Empty:

Student Information