ROLCC Youth Cell Group Sign Up Form

Thank you for your interest in joining a ROLCC Youth cell group! Fill out the following information and we will be in contact with you shortly. Here is a list of the cell groups with the meeting nights for reference.

*Friday groups; all others are Saturday
Junior High Cell Groups
Cupertino JH
*Fremont JH
*Saratoga JH
Sunnyvale JH

Hybrid Cell Groups (combined JH and HS)
Berryessa
*Everygreen
Morgan Hill
Palo Alto
San Mateo

High School Cell Groups
Cupertino 1, Cupertino 2
*Fremont A, *Fremont B
*Saratoga 1, *Saratoga 2

Youth Information
Cell Group *
Youth First Name *
Your answer
Youth Last Name *
Your answer
Youth Email *
Your answer
Youth Cell Phone
Your answer
School
Your answer
2018-2019 School Grade *
Parent Information
Parent 1 - First Name *
Your answer
Parent 1 - Last Name *
Your answer
Parent 1 - Email *
Your answer
Parent 1 - Cell Phone *
Your answer
Parent 2 - First Name
or legal guardian
Your answer
Parent 2 - Last Name
or legal guardian
Your answer
Parent 2 - Email
or legal guardian
Your answer
Parent 2 - Cell Phone
Your answer
City
Your answer
Zip Code
Your answer
Parent's Specialty
if applicable
Parent Volunteer categories
if interested
LIABILITY RELEASE
Offsite Events: LIABILITY RELEASE FORM - Release of All Claims *
In consideration for being invited by River of Life Christian Church (ROLCC) to participate in the off site special events organized by ROLCC located off site from the premises of the facilities located at 1177 Laurelwood Road, Santa Clara, California occurring from August 1, 2018 and any date thereafter, we (I) being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age or older] hereby release, forever discharge and agree to hold harmless ROLCC, its employees, directors, officers, staff members, volunteers, agents, successors, and assigns (collectively “released parties”) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the youth participant that occur while said youth is participating is participating in an off­site special event. Please see EVENTS RUBRIC s hown below. Furthermore, I/we being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age] hereby assume all risks of personal injury, sickness, death, damage and expense as a result of participation in any and all off site special events, meetings and gatherings related to youth ministries. Additionally, I/we give authorization and permission to ROLCC or its representatives to furnish any necessary transportation for my youth participant. This release covers transportation provided by ROLCC and their representatives who are properly licensed to drive in the State of California and who will be driving the youth to/from ROLCC and to/from any other off site event location for the sole purpose of attending the off site special event program and activities. Any deviation from the route to/from ROLCC and to/from off site special event program is not covered under this waiver. And should it become necessary for the youth participant to return home due to medical reasons, disciplinary action, or behaviour requiring special attention, we (I) hereby assume all associated transportation costs. I/We give authorization and permission to ROLCC or its representatives to furnish any f ood and non­alcoholic beverages to my youth participant. I/We will be responsible to make known my son’s/daughter’s food and beverage allergies. Reasonable measures will be taken to make sure food and beverage allergies are avoided for youth participants who may be susceptible to certain dietary allergens. Further, authorization and permission is hereby given to said church to assist in furnishing any necessary lodging for my/our youth participant. Lodging safety is guaranteed to the extent reasonable by the off site hotel or conference center organization providing the accommodations. The undersigned further hereby agree to hold harmless and indemnify River of Life Christian Church (ROLCC), its employees, directors, officers, staff members, volunteers, agents, successors, and assigns for any injury, harm or death sustained by said church as the result of the negligent, willful or intentional acts of my/our youth participant, including any expenses incurred as a result of his or her acts.
Required
Onsite Events: LIABILITY RELEASE FORM - Release of All Claims *
In consideration for being invited by River of Life Christian Church (ROLCC) to participate in church activities organized by ROLCC on church premises, located at 1177 Laurelwood Road, Santa Clara, California, and for activities occurring from Aug 1st, 2018 and any date thereafter,we (I) being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age or older] hereby release, forever discharge and agree to hold harmless ROLCC, its employees, directors, officers, staff members, volunteers, agents, successors, and assigns (collectively “released parties”) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the youth participant that occur while said youth is participating in a church sponsored activity. This release also covers the weekly organized youth group meetings which may take place, from time to time, at the primary residence of youth leader, ministry leader, or other ROLCC church members. We (I) being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age or older] hereby release, forever discharge and agree to hold ROLCC, its employees, directors, officers, staff members, volunteers, agents, successors, and assigns (collectively “released parties”) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child­participant that occur while said child is participating at the primary residence of a youth leader, ministry leader, or other ROLCC church member. Furthermore, I/we being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age] hereby assume all risks of personal injury, sickness, death, property damage and expense as a result of participation in any and all onsite events, weekly youth meetings, and gatherings related to youth ministries. Additionally, I/we give authorization and permission to ROLCC or its representatives to furnish any necessary transportation for my youth participant. This release covers transportation provided by ROLCC and their representatives who are properly licensed to drive in the State of California and who will be driving the youth to/from ROLCC or any other weekly youth group meetings at the primary residence of youth leader, ministry leader, or church member, during youth program and youth activities. And should it become necessary for the youth participant to return home due to medical reasons, disciplinary action, or behaviour requiring special attention, we (I) hereby assume all associated transportation costs. 2 I/We give authorization and permission to ROLCC or its representatives to furnish any food and non­alcoholic beverages to my youth participant. I/We will be responsible to make known my son’s/daughter’s food and beverage allergies. Reasonable measures will be taken to make sure food and beverage allergies are avoided for youth participants who may be susceptible to certain dietary allergens. The undersigned further hereby agree to hold harmless and indemnify River of Life Christian Church (ROLCC), its employees, directors, officers, staff members, volunteers, agents, successors, and assigns for any injury, harm or death sustained by said church as the result of the negligent, willful or intentional acts of my/our youth participant, including any expenses incurred as a result of his or her acts.
Required
Youth Medical Information
Hospital Insurance *
Insurance Company
Required if you have hospital insurance.
Your answer
Insurance Policy Number
Required if you have hospital insurance.
Your answer
Physician's Name
Required if you have hospital insurance.
Your answer
Physician's Phone
Required if you have hospital insurance.
Your answer
List all known medical needs and allergies of the youth
Your answer
Please indicate if your youth has any special need (i.e., social or learning disabilities.) This information will be confidential and will help the Youth Ministry better support your student.
Your answer
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