Youth Group Registration Form

Parents/Guardians of Participant(s)

Participant 1

Participant 2

Participant 3

Participant 4

Emergency Information

Emergency contact person in the event that the above listed parent/guardian cannot be reached.

Consent and Medical Release

Recognizing the possibility of injury or illness, and in consideration for staff and volunteers of Jackson Church who are accepting my son/daughter as a participant in church activities and programs, I consent to my son/daughter participating in the activities and programs. I authorize the transportation of my son/daughter to or from the programs. Any physical limitations that might inhibit full participation, including food allergies, must be provided in writing. I give my consent to have the adult leaders, staff and volunteers to seek medical treatment, if the leader/s feels appropriate, from a licensed medical doctor or dentist to provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.

Pictures and Video

We periodically take pictures and video of our activities for use in our classrooms, church, publications, and social media. We will never publish any personal information. We cannot control, nor do we attempt to control the sharing of pictures and videos or the information associated, that the participants share. We encourage our participants to use the utmost Christian character in all they do, including their online presence. If necessary, appropriate action will be taken either before or after the consultation of parent/guardian depending on the sensitivity of the situation.