Bold Enough Growth Group - Registration under 18
Standard online registration form based on the referenced PDF. Preserve the original field order and include all required, optional, consent, medical, certification, and office-use-only fields.
Participant Information
Full Legal Name
*
First Name
Middle Name
Last Name
Preferred Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Home Address
City
*
State
*
ZIP
*
Tell us about your personal spiritual journey
*
Christian
Seeking to know more
Other
Additional Comments
Preferred Meeting Day/Time
Saturday Morning
Thursday Evening
Other
If Other, Preferred Meeting Day/Time
How did you hear about Bold Enough Growth Groups?
Friend/Family
Social Media
Church
Website
Event
Other
If Other, how did you hear about us?
Parent/Guardian Information
Parent/Legal Guardian Full Name
*
First Name
Middle Name
Last Name
Relationship to Participant
*
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
Parent/Guardian Address (if different from participant)
Is the person completing this form the participant's legal parent or guardian?
*
Yes
No
If no, please explain your legal authority to provide consent
Emergency Contact Information
Emergency Contact Name
*
Emergency Contact Relationship to Participant
*
Emergency Contact Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Secondary Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Email
example@example.com
Is this person authorized to be contacted in an emergency?
*
Yes
No
Medical, Allergy, and Safety Information
Allergies
*
None known
Food
Medication
Environmental
Other
If Other Allergies, please specify
Allergy Details
Medical conditions or special considerations we should be aware of
*
None
Yes
If Yes, medical conditions or special considerations (explain)
Medications that may be relevant during participation
*
None
Yes
If Yes, medications (explain)
Other safety information the parent/guardian believes the organization should know
Consent and Acknowledgments
Participation Consent - Parent/Guardian Initials
*
Christian Faith & Group Environment - Parent/Guardian Initials
*
Code of Conduct Agreement
*
Treat leaders, volunteers, and other participants with respect
Refrain from bullying, harassment, threats, intimidation, or inappropriate conduct
Respect personal boundaries, privacy, and confidentiality of other group members
Follow reasonable instructions provided by Growth Group leaders
Refrain from bringing weapons, illegal substances, alcohol, tobacco, or other prohibited items
Other
Code of Conduct - Parent/Guardian Initials
*
Preferred method of communication
Phone
Text Message
Email
Communication with Parent/Guardian - Parent/Guardian Initials
*
Photo, Video & Media Release
YES - I authorize use of my child's image for organizational purposes
NO - I do not authorize my child's image to be used for promotional or public-facing purposes
Photo, Video & Media Release - Parent/Guardian Initials
*
Transportation Authorization
Transportation authorization will be handled separately for individual events
Transportation Authorization - Parent/Guardian Initials
*
Emergency Medical Authorization - Parent/Guardian Initials
*
Acknowledgment of Responsibility - Parent/Guardian Initials
*
Parent/Guardian Certification
Parent/Legal Guardian Printed Name
*
First Name
Middle Name
Last Name
Parent/Legal Guardian Signature
*
Parent/Guardian Consent & Certification Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Best Phone Number (for Parent/Guardian)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
Minor Participant Certification
Minor Participant Printed Name
*
Minor Participant Signature
*
Minor Participant Acknowledgment - Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Save
Submit Registration
Submit Registration
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