Oakhurst Evangelical Free Church YOUTH MINISTRY CHILD REGISTRATION FORM Child RegistrationMarital Status*I prefer to not answerMarriedDivorcedSeparatedWidow(er)SingleParent Name*Parent Email* Parent Cell Phone*Parent Name*Parent Email* Parent Cell Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home ChurchNumber of Children Being Registered*Please enter a value between 1 and 5.Child InformationMinistry* Middle/High School Awana Sunday Children's Church Child Name*Gender* Male Female Birthday* Grade*Please list any: Medical Conditions, Activity Restrictions, Drug/Food/Other Allergies:Release Waiver*I can, as the parent or legal guardian of this child request that they be released from church care without an authorized, designated adult listed above being present. In requesting this release, I affirm that I will hold OEFC harmless from any liability or action arising out of the release. If at any time in the future I would like to change this release I will notify OEFC, in writing, my requested change to this waiver. I affirm my choice by check box marked below. Release my child without any authorized person present DO NOT Release my child without any authorized person present *PHOTO RELEASE: I hereby grant to Oakhurst Evangelical Free Church and to its employees, agents and assigns the right to photograph me or my dependent and to use the photo and or other digital reproduction of him/her to other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital, or electronic publishing via the internet. I understand and agree to the above Photo terms. I understand and DO NOT agree to the above Photo terms. Ministry* Middle/High School Awana Sunday Children's Church Child NameGender* Male Female Birthday GradePlease list any: Medical Conditions, Activity Restrictions, Drug/Food/Other Allergies:Release Waiver*I can, as the parent or legal guardian of this child request that they be released from church care without an authorized, designated adult listed above being present. In requesting this release, I affirm that I will hold OEFC harmless from any liability or action arising out of the release. If at any time in the future I would like to change this release I will notify OEFC, in writing, my requested change to this waiver. I affirm my choice by check box marked below. Release my child without any authorized person present DO NOT Release my child without any authorized person present *PHOTO RELEASE: I hereby grant to Oakhurst Evangelical Free Church and to its employees, agents and assigns the right to photograph me or my dependent and to use the photo and or other digital reproduction of him/her to other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital, or electronic publishing via the internet. I understand and agree to the above Photo terms. I understand and DO NOT agree to the above Photo terms. Ministry* Middle/High School Awana Sunday Children's Church Child NameGender* Male Female Birthday GradePlease list any: Medical Conditions, Activity Restrictions, Drug/Food/Other Allergies:Release Waiver*I can, as the parent or legal guardian of this child request that they be released from church care without an authorized, designated adult listed above being present. In requesting this release, I affirm that I will hold OEFC harmless from any liability or action arising out of the release. If at any time in the future I would like to change this release I will notify OEFC, in writing, my requested change to this waiver. I affirm my choice by check box marked below. Release my child without any authorized person present DO NOT Release my child without any authorized person present *PHOTO RELEASE: I hereby grant to Oakhurst Evangelical Free Church and to its employees, agents and assigns the right to photograph me or my dependent and to use the photo and or other digital reproduction of him/her to other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital, or electronic publishing via the internet. I understand and agree to the above Photo terms. I understand and DO NOT agree to the above Photo terms. Ministry* Middle/High School Awana Sunday Children's Church Child NameGender* Male Female Birthday GradePlease list any: Medical Conditions, Activity Restrictions, Drug/Food/Other Allergies:Release Waiver*I can, as the parent or legal guardian of this child request that they be released from church care without an authorized, designated adult listed above being present. In requesting this release, I affirm that I will hold OEFC harmless from any liability or action arising out of the release. If at any time in the future I would like to change this release I will notify OEFC, in writing, my requested change to this waiver. I affirm my choice by check box marked below. Release my child without any authorized person present DO NOT Release my child without any authorized person present *PHOTO RELEASE: I hereby grant to Oakhurst Evangelical Free Church and to its employees, agents and assigns the right to photograph me or my dependent and to use the photo and or other digital reproduction of him/her to other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital, or electronic publishing via the internet. I understand and agree to the above Photo terms. I understand and DO NOT agree to the above Photo terms. Ministry Middle/High School Awana Sunday Children's Church Child NameGender* Male Female Gender*MaleFemaleBirthday GradePlease list any: Medical Conditions, Activity Restrictions, Drug/Food/Other Allergies:Release Waiver*I can, as the parent or legal guardian of this child request that they be released from church care without an authorized, designated adult listed above being present. In requesting this release, I affirm that I will hold OEFC harmless from any liability or action arising out of the release. If at any time in the future I would like to change this release I will notify OEFC, in writing, my requested change to this waiver. I affirm my choice by check box marked below. Release my child without any authorized person present DO NOT Release my child without any authorized person present *PHOTO RELEASE: I hereby grant to Oakhurst Evangelical Free Church and to its employees, agents and assigns the right to photograph me or my dependent and to use the photo and or other digital reproduction of him/her to other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital, or electronic publishing via the internet. I understand and agree to the above Photo terms. I understand and DO NOT agree to the above Photo terms. Medical InformationMedical Insurance CarrierPolicy #Other Adults authorized to Pickup my Child(ren)Additional Individuals may be listed in the comments section below.Contact NameRelationship to ChildPhoneContact NameRelationship to ChildPhoneContact NameRelationship to ChildPhoneAcceptance and CommentsWe hereby release the Oakhurst Evangelical Free Church and the above mentioned Children Programs and/or Children Program leaders from liability in case of injury or illness to the above named Child(ren). The above named child(ren) has my permission to participate in the activities in the above named Children Programs. If I/we cannot be reached in the event of an emergency, I give my permission for necessary medical care, to secure proper treatment and to order injections, anesthesia or surgery for the above named child(ren). I understand that all billings for service not billed to my insurance carrier will be billed to me as a parent/guardian.* I understand and agree to the above terms of service. Additional comments Δ This iframe contains the logic required to handle AJAX powered Gravity Forms.
