G.O.A.L.S :: Registration Intake :: Forms To Complete
Please complete the following Registration, Medical Form, Media Release and Parent/Student Statements, in its entirety, so we may have your child(ren)'s pertinent information. If you have any questions regarding these forms, please email goalsymposium@gmail.com.

Please note - By your completion and submission of this form, you authenticate the following information, which will serve as your electronic signature. Thank you very much!

Email address *
Youth Participant's First and Last Name *
Your answer
Participant's Home Address *
Please include street number, street, apartment number (if applicable), city and zip code.
Your answer
Register for the G.O.A.L.S Symposium: *
Required
Participant's Age *
Your answer
Participant Is Entering Grade...
Your answer
Parent's First AND Last Name *
Your answer
Parent's Main Contact Number *
Your answer
:: MEDICAL FORM ::
Emergency Contact's Name and Phone Number *
Your answer
Doctor's Name *
Your answer
Doctor's Address *
Please include street number, street name, suite number [if applicable], city, zip code.
Your answer
Doctor's Phone Number *
Your answer
Permission to give Tylenol? *
Permission to give Benadryl? *
Permission to give Claritin? *
Permission to give Visine Eye Drops/eye wash? *
Child uses EpiPen and/or inhaler? *
If "Yes," please specify either "EpiPen" or "Inhaler" in the "Other" field. Please provide with your child each day.
Any known allergies or severe health problems?
If this does not apply to your child, continue to the next question.
Your answer
Are there any specific accommodations for your child to participate in this program?
If this does not apply to your child, continue to the next question.
Your answer
Are there any other allergy medications we need to be aware of? Please list below.
If this does not apply to your child, continue to the next question.
Your answer
Dietary Restrictions: *
Share what your child is allergic to and what they cannot eat. If there are no allergies, please type "N/A." Please note if your child has gluten allergies, food from home should be provided.
Your answer
:: MEDIA RELEASE ::
"I give my full consent to G.O.A.L.S Symposium to publish and copyright all photographs in which the above-mentioned child appears as a participant in any and all classes, events, or programs sponsored by G.O.A.L.S. I further agree that G.O.A.L.S. may, at any time and from time to time, transfer, use or cause to be used such photographs in G.O.A.L.S. brochures, newsletters, advertising, posters, displays, websites, slideshows, G.O.A.L.S. Facebook page, videotapes, catalogs, and other similar publications or literature, without limitations or reservations. THIS IS A BLANKET CONSENT FOR ALL PHOTOGRAPHS TAKEN OF YOUR CHILD. OPTING OUT OF A SPECIFIC MEDIUM IS NOT AN OPTION. If you approve, your child's photograph may be used in any of the above-mentioned media. If you disapprove, your child's photograph WILL NOT appear in any materials from G.O.A.L.S. *
:: PARENT/STUDENT STATEMENTS ::
Students are expected to be respectful of adults and of one another at all times.
Students are expected to listen and respond appropriately to adults.
Students are expected to respect school property and the property of others.
Students are expected to respect other children and to listen to their wishes regarding personal space, personal belongings, etc.
Students are expected to follow classroom rules.
Students are expected to be honest.
Students are expected to participate in all 3 days of the workshop, If they are unable to attend, they will communicate with leadership and take responsibility to get information they have missed.
Participation in culmination presentations are mandatory.
Accessing sites is not allowed in the classroom unless requested by a presenter for a workshop.
Physically aggressive behavior is not acceptable.
Inappropriate and/or offensive language is not acceptable.
Completion of surveys as honestly as possible is mandatory and helps us to to improve our services to you and your child.
:: STATEMENT OF PARENTAL SUPPORT ::
As a parent of a participant attending the G.O.A.L.S. Symposium, I understand that it is my responsibility to support the church's philosophy and uphold the church's standard of academic and moral excellence. I will be responsive to teacher and administrative communication. I have read the behavioral expectations and discussed then with my child. My child will strive each day to meet these expectations. ion20I understand that these expectations will enhance the experience that my child receives from The G.O.A.L.S. Symposium. With my submission of this form, I agree to make a commitment to meet obligations to support my child’s center of learning.
:: The ideas and opinions expressed during the G.O.A.L.S. Symposium do not necessarily reflect those of Central United Methodist Church or any of our sponsors. ::
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