Student Registration

STUDENT REGISTRATION

Great Oak Church | 4:12 Students + GO Kids

This form will be used for Sunday School, Youth Group activities, Camp, etc.

Student Information

First Name

Last Name

Gender

Birthdate

Grade

Does this child have a medical or developmental concern/diagnosis that requires special accommodations?

Yes

No

Please explain any symptoms or sensory needs (seeking and avoiding) and anything else that you would like us to know (likes/dislikes).

Allergies

Parents/Guardians

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Acknowledgement

I/We acknowledge that I/we are the parent or legal guardian of the minor(s) listed.

Permission

I/we give permission to my/our child to attend and participate in activities sponsored by Great Oak Church (GOC).

Medical Authorization

Should my/our child become ill or injured during a GOC sponsored event, I/we authorize the group leaders/authorized personnel, in whose care the minor has been entrusted to rely on the advice of licensed medical physicians(s) and/or dentist(s), and in reliance on this medical/dental judgment to consent to any and all necessary medical and/or dental treatment, which may include x-rays, diagnostic/radiological tests, administration of medications and/or anesthesia, surgical intervention, and/or hospitalization. I/We shall be liable and agree to pay all costs and expenses incurred in the connection with such authorization. Should it be necessary for my/our child to be transported by an authorized emergency medical vehicle due to medical reasons or otherwise, I/we shall assume all costs and expenses related to such transportation and related emergency medical treatment.

Release

I/We do hereby release GOC and all associated parties including cooperating churches and trained personnel of liability in the case of injury to any participants in the programs provided by GOC. GOC cannot and should not be held responsible for a minor's conduct that violates rules established by GOC to protect him/her from harm or injury. Should my/our minor child violate any of GOC's rules, policies, or procedures or behave in a manner inconsistent with GOC's mission and philosophy while participating in the GOC sponsored event, I/we acknowledge that said minor child may be sent home at my/our expense. Registration and participation grants GOC permission to use photos taken during programming, which may include my/our child, for advertising and promotional purposes without my consent. This release covers all GOC sponsored events/programs in which my/our child participates.

Signature