FW Friends Registration Form

FW Friends Registration 2020/2021

Wednesday Outreach Program for K-6th
Child's Name*

First NameLast Name
Child's Grade*

Kindergaten1st2nd3rd4th5th6th
Child's Birthday*

MonthDayYear
This information is used to celebrate students at FW Friends during the birthday
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Parent/Guardian E-mail*
Parent/Guardian Phone Number*

Area CodePhone Number
Any known allergies and/or diet restrictions we should know about you child?*
If no known allergies, please type 'N/A'
Any medical conditions we should know about your child?*
If no known medical conditions, please type 'N/A'

Emergency Contact Information
Contact Name*

First NameLast Name
Mailing Address (If different from child)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*

Area CodePhone Number
Work Phone Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Is the participant covered by personal/family medical insurance? *
Health Insurance Provider*
If child does not have health insurance, please write 'Not Available.'
Policy Number
If I am unable to pick-up my child from FW Friends, I give permission to the following person(s) to pickup my child.
By providing a signature, you give permission to the person(s) listed above to pick-up your child.*

Clear
By providing an electronic signature, you are in agreement that this consistutes your signature as if you were actually writing (electronic signature). This signature represents

Participation Agreement

Please carefully read through the following information carefully.
We are excited to have your child join us!

At Glen Lake Church, the safety of your child is important to us. We want you to know that all of the volunteers who work in our FW Friends ministry are background checked, have agreed to follow our Child Protection Policies and Procedures and want to do all they can to make this event safe and enjoyable for each child. In that light, we ask you to read and then sign the following liability statements.

I acknowledge that participation in FW Friends involves risk to the child (and to the child’s parents or guardians, if the child is a minor), and may result in various types of injury including, but not limited to, the following: bodily injury, death, emotional injury, property damage, financial damage, and sickness.

In consideration for the opportunity to participate in FW Friends, the parent/legal guardian acknowledges and accepts the risks of injury associated with participation in the activity. The parent/legal guardian accepts personal financial responsibility for any injury or other loss sustained during the activity, as well as for any medical treatment rendered to the child that is authorized by the event coordinator or its agents, employees, volunteers, or any other representative (collectively referred to as the “Glen Lake Community Reformed Church”).

Further, the parent/legal guardian releases and promises to indemnify, defend and hold harmless Glen Lake Community Reformed Church for any injury arising directly or indirectly out of the described activity, whether such injury arises out of the negligence of the Glen Lake Community Reformed Church, the child, or otherwise.

If a dispute over this agreement or any claim for damages arises, the parent/legal guardian agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the parent/legal guardian and Glen Lake Community Reformed Church cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

I hereby authorize the leaders of the ministry function, event or activity to obtain emergency medical care and/or treatment deemed necessary for my child.

I acknowledge and understand that I am welcome to participate in the ministry function, event or activity under the guidance of the leaders of the function/event/activity, at my own expense.

I acknowledge and understand that all of the participants attending this function, event, or activity will be advised, and required to abide by, the code of conduct and rules established by the leaders for this function, event, or activity. Failure to follow the code of conduct and/or rules established may require the parent or legal guardian to pick-up their child at their own expense.
Full Legal Name*

PrefixFirst NameLast NameSuffix
Signature of parent or legal guardian*

Clear
By providing an electronic signature, you are in agreement that this constitutes your signature as if you were actually writing (electronic signature). This signature is hereby adopted by you and represents your intent to acknowledge the statement provided above in the Document.
Date*

MonthDayYear
Date

Photo Use Agreement

Please read the following statements in regards to the Photo Use Agreement. You have the option to choose YES or NO.
YES, I hereby give permission to Glen Lake Community Reformed Church to store and use photos and videos taken of my child during FW Friends for printed, electronic and website publications.NO, I do not give permission to Glen Lake Community Reformed Church to store and use photos and videos taken of my child during FW Friends for printed, electronic and website publications.
Parent or legal guardian name*

PrefixFirst NameLast NameSuffix
Signature of parent or legal guardian*

Clear
By providing an electronic signature, you are in agreement that this constitutes your signature as if you were actually writing (electronic signature). This signature is hereby adopted by you and represents your intent to acknowledge the statement provided above in the Document.
Today's Date*

MonthDayYear
Date
Should be Empty:

FW Friends Registration 2020/2021

Emergency Contact Information

Participation Agreement

Photo Use Agreement