Westview Youth Registration 2020-2021
Please fill out 1 form per child.
CHILD INFORMATION
Name *
Age *
Grade & School *
Birthdate *
MM
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DD
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YYYY
Address *
Cell Phone number (If applicable) *
Allergies or Medical Conditions (This will remain confidential, but it helps us to know how to best serve our students) *
Medicare # *
What Social Media (if any) does your child have access to? (Please list their handles if applicable) *
Best way to for us contact your child (please answer according to what your child checks the most) *
PARENT/GUARDIAN INFORMATION
Name(s) *
Email *
Cell Phone *
Home Phone *
Relationship to Student *
SECONDARY EMERGENCY CONTACT
Name *
Cell Phone *
Home Phone *
Relationship to Student *
MINOR PHOTO/VIDEO RELEASE
Westview Bible Church periodically uses pictures and video footage to provide updates and news on our ministry programs, and for promotional purposes on our website, social media, and brochures. Do you consent to your child’s image to be included in any picture or video that Westview Bible Church uses for these purposes? *
Purposes and Extent:
Westview Bible Church is collecting and retaining this personal information for the purposes of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Westview Bible Church to limit the information collected or to view your child’s information, please contact us.
CONSENT
Does the Westview Youth team have permission to contact your student directly? *
Including: Calls, texts, emails, Zoom Call, Mailers, Direct Messages
I/We, the parent(s) or guardian(s) named above, authorize the ministry staff of Westview Bible Church to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named above.I/We, named above, undertake and agree to indemnify and hold blameless the ministry staff, Westview Bible Church, its Pastors, Directors, and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Westview Bible Church, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization are effective only when participating in or traveling to events of Westview Bible Church. Please enter your name and date below as a digital signature. *
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