New Participant Registration
Rising TIDE is offers programming virtually and in-person -- Monday thru Thursday from 12:30 pm to 6:00 pm for preschool & elementary aged students and from 2:00 pm to 8:00 pm for middle school & high school students. 

We will be following up with you personally once receiving your application. We look forward to being in life with you and your family!

To everyone, please be sure to read carefully and complete this application as soon as possible. 
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Email *
Parent/Guardian's Phone Number *
Child's First and Last Name *
Date of Birth *
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Address *
School *
Fall 2025 Grade Level: *
Allergies: *
I am interested in homework help (K-12th Grade). Choose all that apply. *
Monday
Tuesday
Wednesday
Thursday
I am not interested at this time
In-Person
Virtual
Hybrid
I am interested in one-on-one tutoring (K-12th Grade). Choose all that apply. *
Monday
Tuesday
Wednesday
Thursday
I am not interested at this time
In-Person
Virtual
Hybrid
I am interested in receiving further information about specialized clubs. *
I am interested in Specialized Youth (6th-12th Grade)  Programming. *
I am interested in receiving school supplies. ($5 per child) *
I am interested in receiving more information about transportation from school to the program and from the program to home.
Clear selection
Please indicate your electronic needs status for this academic year: *
I am interested in picking up groceries. Choose all that apply. *
Required
Comments

I am the parent or legal guardian of the participant named above (Minor). The undersigned desires for said Minor to attend and/or participate in ministries, events, programs, functions, and activities (hereinafter referred to as “Activity” or "Programming"), sponsored by, connected with, or related to CPC (Covenant)/MKEC (Rising TIDE) (not-for-profit corporations). I understand and acknowledge that neither CPC or MKEC will allow the Minor to participate in any Activity/Programming without releasing and holding CPC/MKEC harmless from any liability arising out of the Minor’s attendance and/or participation in that Activity, including the Minor’s transportation to and from the Activity, if provided by the CPC or MKEC.

I have or will investigate all risks involved with the Minor’s attendance and/or participation in any Activity/Program, and further as the parent or legal guardian of said Minor assume any and all risks of personal or bodily injury to said Minor or property damages associated with said Activity. 

By signing this document, on behalf of myself and the Minor, I hereby release and forever discharge CPC/MKEC, its officers, directors and employees, agents and any parties volunteering on behalf of CPC/MKEC from all claims, damages, costs or expenses of any kind arising out of or related to the Minor’s attendance or participating in any CPC/MKEC Activity.

I understand that this document is a full complete Release of all claims for personal or bodily injury and property damage which the Minor might sustain as the results of the Minor’s attendance and/or participation in any CPC/MKEC Activity, regardless of the specific cause thereof, and I further understand that in the event of such personal or bodily injury to the Minor, or property damage, that I cannot seek , on behalf of the Minor or myself, any type of recovery or reimbursement whatsoever from CPC/MKEC or their officers, directors, employees, agents or any parties volunteering on behalf of CPC/MKEC.

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In the event the Minor suffers an injury or condition during his or her participation in the Activities, including transportation to and from the Activity, which may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if medical treatment is delayed, and reasonable attempts to contact me have been unsuccessful, I hereby appoint CPC/MKEC as my Agent to act for me and in my name to make any and all decisions for the Minor concerning his or her personal care, medical treatment, hospitalization and health care. This power of attorney and delegation of authority shall terminate when the Agent is first able to contact me.
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Regarding photographs taken at any CPC/MKEC event, I give CPC/MKEC permission to do the following for non-profit use and without charge:  use at CPC/MKEC, display at an event, use in a multimedia presentation, reprint and distribute for any CPC/MKEC non-profit publication with copyright to accompany photo or display on the CPC/MKEC websites.
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I authorize my child's in-person and/or virtual participation in Rising TIDE, knowing they might be recorded within a class/session in order to ensure a safe environment and quality programming. 
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Virtual Signature (Parent's or Guardian's Name) *
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