North Harbor Community Church- Floodgate Student Information Form
Sign in to Google to save your progress. Learn more
Today's date is: *
MM
/
DD
/
YYYY
Floodgate group: *
Required
Student's Full Name: *
Student Address: *
Student's School and Current Grade: *
Student's Email address: *
Student's phone number:
It is OK for Floodgate Volunteers to Contact your Student: *
Required
Clear selection
Clear selection
Parent Name: *
Parent Address:
Parent Email: *
Would you like to receive Floodgate updates and parent resources via e-mail? *
Parent(s) phone number(s): *
I give permission for my student to be photographed at church and for his/her/their likeness(es) to be displayed/published in church materials *
Student's Favorite Activities:
Student Health information:
Please Describe your Child's Relationship with God (past and current):
Is there anything else we should know about your child (social concerns, learning disabilities, etc.)?
I give my permission for the North Harbor/Floodgate staff and volunteers to authorize emergency medical treatment for my child in the event of unexpected illness or injury to my child. I understand that every reasonable attempt will be made to contact me in the event of such an emergency. *
I give my permission for my child to attend various meetings, events, and activities with Floodgate over the course of the 2020-2021 year. I hereby hold harmless any and all North Harbor staff, volunteers and all other parties associated with North Harbor Community Church for any injury, death, loss of property, or any other unforeseen event that negatively impacts me, my student, or our family because of my child(ren)'s attendance at said meetings, events, or activities with Floodgate. I understand that I have the right to not allow my child to attend anything related to Floodgate, and that my allowance of my child(ren)'s attendance (or my child(ren)'s attending of these meetings, events or activities by their own volition) signifies my willingness to hold North Harbor Community Church (and affiliated personnel) harmless from any and all allegations and accusations. I acknowledge that I am responsible for providing transportation for my child(ren) to and from all Floodgate events and activities and any arrangements made for my child(ren) to be transported by someone other than myself are my own personal responsibility and do not fall under the purview of Floodgate or North Harbor Community Church. *
Parent/Guardian Electronic Signature: *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of North Harbor Community Church. Report Abuse
Google Forms