KidZone Student Registration Form

EDGE Youth Student Registration Form

Program Year 2025-2026
Student Information
Student Name*

First NameLast Name
Birth Date

MonthDayYear
Grade*
MaleFemale
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is there anything else you would like us to know about the student?
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Format: (000) 000-0000.
Cell Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Alt. Phone Number*
Format: (000) 000-0000.
YesStudent has permission to walk home alone after dark
YesNo
YesNo

Informed Consent and Acknowledgement

By registering your child for Olivet Baptist Church's EDGE Youth Program, you acknowledge and agree to the following:
- You are providing accurate and complete information about your child's health, medical conditions, and any other relevant factors that could impact their participation in the program.
- You understand that participation in the EDGE Youth Program involves activities that may include physical exercises, crafts, and other age-appropriate activities, and you consent to your child's participation in these activities.
- You understand that while Olivet Baptist Church and its volunteers will take reasonable precautions to ensure the safety of your child, there are inherent risks in any activity. These risks include, but are not limited to, accidents, injury, or other incidents that could occer while being transported in a volunteer's vehicle. By enrolling your child, you assume responsibility for any risks involved in your child's participation.
- You have had the opportunity to ask questions you may have regarding the activities, volunteers, and safety measures in place.
If you do not wish for you child to participate in certain activities, please specify those exclusions below.
Medical Release and Emergency Authorization

By submitting this form, you authorize Olivet Baptist Church to seek emergency medical treatment for your child if necessary and if you or an emergency contact cannot be reached. This consent includes but is not limited to:
- Authorization for Olivet Baptist Church volunteers to arrange for emergency medical care or treatment for your child if you cannot be reached.
- You agree to bear all costs for medical services provided to your child during EDGE Youth Programs.
- You acknowledge that all medical information provided is accurate and current to the best of your knowledge. You also agree to inform Olivet Baptist Church of any changes to your child's health condition or emergency contact information.
Photo and Video Release Authorization

By registering your child for Olivet Baptist Church's EDGE Youth Program, you grant Olivet Baptist Church the right to use your child's image, photograph, or video in promotional materials, social media posts, or other content related to the program. This authorization includes:

Permission for your child to be photographed or filmed during program activities by our designated program photographer.

Use of these images and videos in marketing materials, including but not limited to printed materials, websites, social media, and other promotional content, without compensation or prior approval.

You acknowledge that these images/videos may be used publicly, and you release Oliver Baptist Church from any claims or liability arising from the use of your child's image or video.
I do not consent to the use of my child's image or video for promotional purposes.
Data Protection and Privacy

All personal data provided in this form will be handled in accordance with Olivet Baptist Church's Privacy Policy and applicable data protection laws. We will use your information only for the purposes of program registration, emergency contact, and communication related to the EDGE Youth Program.
Yes
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EDGE Youth Student Registration Form