Middle and High School Registration Form

Basic Contact Information

Thanks for trusting us to serve your child during youth group, HS Life Group, and more. It would be helpful for us to have your contact information, along with some other things, so thanks for taking time to fill out this form. Contact Kirstin in the church office at 641.648.3305 with any questions.

Child 1 Name

Child 1 Grade

Child 1 Phone

Child 1 Address

Child 2 Name

Child 2 Grade

Child 2 Phone

Child 2 Address

Child 3 Name

Child 3 Grade

Child 3 Phone

Child 3 Address

Parent/Guardian 1 Name

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 1 Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Emergency and Permission/Release Information

Emergency Contact Name

Emergency Contact Phone

Please tell us about any food allergies we should know about (please include child's name if multiple children are on the form):

Please tell us about any medical conditions we should know about (please include child's name if multiple children are on the form):

I permit volunteers from Iowa Falls Evangelical Free Church or other parents to provide transportation during any youth group activity.

Yes No

I give permission for Iowa Falls Evangelical Free Church to use photos or video clips of my children on the church's social media sites or website to help promote the youth ministries.

Yes No

Participation Agreement: I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor 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.

Yes No

Electronic Signature (Type Name)

Date

Middle and High School Registration Form

Description

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