Group of Awesome Registration

Parent Information:
Cell phone: (required)
Home phone:
Other phone:
Additional person(s) to pickup child?

Name, First, Last

Child Information
Gender (required)
Parent/Guardian Acknowledgement
ADA Policy: Parents have the obligation to disclose significant, medical, physical or behavioral issues at the time of the child’s enrollment and on an ongoing basis. Due to the format of our program, we are not always able to provide one-on-one care for any child except on an intermittent basis, such as injuries, immediate disciplinary issues and certain personal care needs.
Waiver for Medical Treatment: In the event that my child requires emergency medical treatment and I cannot be reached, I hereby authorize the Highpoint Children’s Ministry staff to make arrangements to transport my child to the physician, hospital or clinic that I have designated or the nearest hospital/emergency medical facility. I give my consent for any and all necessary medical care treatment for my child during this time.
Waiver for Participation: I understand that Highpoint Children’s Ministry activities have inherent risks and hereby assume all risks and hazards as a result of my child’s participation in all ministry programs and facilities including transportation to and from said activities. I further release, absolve, indemnify, and agree to hold harmless, the Highpoint Children’s Ministry, the organizers, supervisors, directors, staff, volunteers, participants, as well as persons or parents transporting participants to or from such activities from any claims or injury sustained during my use of Highpoint facilities or participation in any Highpoint activity, whether located on Highpoint property or not.
Waiver for Photo/Video Release: I give my consent for any photos or videos taken of my child involved in Highpoint Children’s Ministry programs to be used for promotions, trainings, etc. for church use only.
I have read and agree to the Parent/Guardian Acknowledgement. Date (Firefox format YYYY-MM-DD):
Please add your signature in the box below with your mouse, finger, or stylus: