Emmanuel Youth

Student Info

Name

Phone

Address

Date of Birth

Grade

School

Allergies?

Yes No

If yes, please indicate:

Parent/Guardian Info

Parent/Guardian #1

Relationship to Student:

Phone

This address will receive a confirmation email

Parent/Guardian #2

Relationship to Student:

Phone

This address will receive a confirmation email

Permission & Consent

In the event of an accident or emergency, when a parent/guardian is unavailable: A representative of Emmanuel Community Church is hereby authorized to make such arrangements as they consider necessary for your child to receive medical/hospital care, including necessary transportation. Under such circumstances, we further authorize the attending physician to undertake such care and treatment of the student as they consider necessary. I understand that every reasonable effort will be made to contact the emergency contact(s) listed.

I agree and authorize I do not agree

During church programs and events, photos or videos may be taken for use on Emmanuel Community Church’s website, social media, printed materials, or other church communications. Please indicate your permission below regarding the use of photos or videos that may include your child.

Yes, I give permission No, I do not give permission

Waiver and Release

I, the undersigned parent or legal guardian, acknowledge that Emmanuel Community Church is committed to providing a safe and supportive environment for children and follows established policies and procedures designed to protect participants and respond appropriately in the event of an accident or emergency. I understand that participation in church programs and camps may involve activities that carry inherent risks despite reasonable supervision and safety precautions. On behalf of my child(ren), I voluntarily assume those risks associated with participation. To the extent permitted, I agree to release and hold harmless Emmanuel Community Church, its pastors, staff, and volunteers from liability for accidental injury or loss that may occur during participation in church programs or camps, provided that reasonable care and established church safety policies are followed. I confirm that I have read and understood this Waiver and Release of Liability and agree to its terms.

I have read and agree to the Waiver and Release of Liability above. (Required to complete registration)

Acknowledgment

By submitting this form, I acknowledge that I have read and agree to the Waiver and Release of Liability & Consent & Permission above. I understand that Emmanuel Community Church reserves the right to interpret, modify, or update its policies and procedures as necessary. I also understand that camp registration fees are non-refundable, as Emmanuel Community Church purchases supplies, materials, and resources in advance based on the number of registered participants. Due to these upfront costs, refunds cannot be issued in the event of absence, or withdrawal. I confirm that I have read and understand this acknowledgment and agree to it as part of my child(ren)’s registration.

Emmanuel Youth

Description

Please Fix the Following