Skala Registration 2024-25

TEEN REGISTRATION

SECOND SLAVIC BAPTIST CHURCH
ONLY FOR TEENS IN 7TH-10TH GRADE LEVELS
Teen's Name*

First NameLast Name
Teen's Birth Date*

MonthDayYear
Grade Level*
Teen's Number (DON'T include if none)
Gender*

MaleFemale

Teen's parents/guardians:*

	First Name	Last Name	Phone Number
1
2

What church are you (parent) a member of?*

I don't go to churchSSBCOther
If you're new to Skala, you will be invited to join a Skala Notifications Viber Community. Please do not ignore this invitation. It is MANDATORY that you join so you will be notified about all future Skala events!
MEDICAL INFORMATION: In the event of an accident or any other emergency, when a parent/guardian is unavailable, I hereby authorize a representative of the church to make arrangements as he/she considers necessary for my child to receive medical or hospital care, including necessary transportation. Under such circumstances, I further authorize the physician named above to undertake such care and treatment of my child as he/she considers necessary. In the event said physician is not available at any time, I authorize such care and treatment to be performed by any licensed physician or surgeon.

THE UNDERSIGNED PARENT/GUARDIAN FULLY UNDERSTANDS HE/SHE IS RESPONSIBLE TO PAY ALL COSTS INCURED AS A RESULT OF THE FOREGOING.
Physician's Name*

First NameLast Name
Physician's Phone Number*
Please enter a valid phone number.
Medical Insurance Carrier*
Policy Number*
List of allergies to food or medicine (if any)
Release of Liability

California Law provides as follows: "All persons making the field trip or excursion shall be deemed to have waived all claims against the church or the state of California for injury, accident(s), and illness, death accruing during or by reason for the field trip or excursion" (Education code § 35330). The Church makes every effort to protect all pupils but does not assume any liability for injury. Weapons are strictly forbidden (any sort of guns, knives, etc.). Drugs, tobacco and alcohol are strictly forbidden. If any of the above is found, it will be taken away and may be reported. I give permission to ministry leaders to provide transportation to and from homes and places where ministry events will take place and will not hold anyone liable if something unexpected occurs and will result in any accidents. I hereby give consent to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of myself or my child to use in any public media, including internet, social media, print or in any of the organization’s or its partners’ publications, productions, or posts. I understand that the intended use of such images and information is solely for the purpose of the promotional and public awareness purposes for the organization. I hereby waive any rights or interest in the images or recordings, as contemplated in this release. My signature below indicates that I have read and understand this form and that the information provided is true and correct to the best of my knowledge.
Parent/Guardian submitting this form*

First NameLast Name
Parent/Guardian Signature*

Clear
My Products*
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SKALA REGISTRATION
$20.00

Total

$0.00
Email (to receive payment confirmation)*
example@example.com

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

TEEN REGISTRATION

Release of Liability