Clone of CASI 2025 Registration Form

REGISTRATION APPLICATION

July 13th - 17th 2026
Congratulations!! You have started the first step to an amazing creative experience!
General Information

Please Fill Out the Following Information for Student and Parent/Guardian.
Student information:
Student’ s Name

First NameLast Name
Birth Date

MonthDayYear
Grade in Spring of 2025
Students must be as young as an upcoming 6th grader or as old as an upcoming college freshman - 5th graders and college freshmen will not be accepted
How did you hear about us?*
MaleFemale
Extra SmallSmallMediumLargeX-LargeOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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.

2026 Medical Release Form
Student's Name

First NameLast Name
Current Grade
School Student Attends
Student's Email
example@example.com
School Student Attends
Please enter a valid phone number.Format: (000) 000-0000.
MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Insurance Company
Claims To Be Mailed To
Policy or ID Number
Family Physician
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medications Currently Taking (list all, even vitamins)
List Allergies
Date

MonthDayYear
Date
IbuprofenAcetaminophenAspirin
Special Instructions Regarding Student
My child: Student's Name may participate in all S.T.A.N.D, Inc & Church on The Living Edge (Further known as: COTLE) events for the summer of the 2026, calendar year. As a parent or guardian, I authorize an adult counselor to make legal decisions, medical decisions or otherwise concerning said minor during the time of S.T.A.N.D, Inc & COTLE events. I also agree that I will immediately notify S.T.A.N.D, Inc & COTLE, in writing, of any changes to the information above, medical or otherwise. I hereby release S.T.A.N.D., Inc, COTLE, and its sponsors of any legal responsibilities and liability in the event of an accident or injury. As a parent or guardian, I have carefully and truthfully provided all the information requested and give my permission for my child to participate in S.T.A.N.D, Inc & COTLE events in 2026. Both my child and I understand that he/she will be expected to obey the rules, regulations and policies of S.T.A.N.D, Inc & COTLE events.
Parent/Guardian Signature
Date

MonthDayYear
Date
Student Signature
Date

MonthDayYear
Date

Parent Permissions

Parents Should Read the Following Materials and Release Consent and their Acknowledgment through Signature. Forgery by Student or Unauthorized Persons will Result in Immediate Disqualification for Acceptance and/or Expulsion.
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by the CASI administrative team during the selected intensive. In exchange for the acceptance of said child’s candidacy by CASI, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless CASI, Church on the Living Edge and the S.T.A.N.D. Inc and all thier respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participating in selected CASI sessions.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature

Photo & Media Release Waiver
I,Parent/Legal Guardian grant, S.T.A.N.D, Inc & Church on the Living Edge, my permission to use photographs for any legal use including but not limited to: publicity, copyright purposes, illustrations, advertising, and web content. Furthermore, I understand that no royalty, fee or compensation will become payable to me by reason of any use.
I am of legal ageI am a minor and represented by my parent/guardian
I declare true my age of consent, and in case I am under the age of such consenting age, I have obtained the required consent from my parents/guardians as evidenced by the signatures below:
Name(s) of child/children
Email
example@example.com
Signature of Parent/Guardian
Date Signed:

MonthDayYear
Date

Should be Empty:

REGISTRATION APPLICATION

General Information

Student Creative Interest

2026 Medical Release Form

Parent Permissions

Photo & Media Release Waiver