Student Ministry Registration

Student First and Last Name

Parent Guardian Name 1

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 1 Phone

Parent Guardian Name 2

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Address

Student Email

May we have your permission to email your child? Yes No

Student Phone Number

May we have your permission to call or text your child regarding ministry information or for connection purposes?

Yes No

Student Birthdate

Student Grade Level

Student's School

Do you consent to your child's photos being used in newsletters, promotional tools like brochures, social media, or other uses deemed appropriate by Neelsville Presbyterian Church?

Yes No

Does your child have any medical concerns and/or allergies? Please describe or type "no."

Please describe anything else that would be helpful for us to know about your child so we can best minister to him/her.

I give permission for Neelsville staff and leaders to call emergency personnel and give appropriate treatment for my child in the event I cannot be reached during a medical emergency. I understand that I, the parent or guardian, have financial responsibilty and liability for my child's illness or injury incurred on site at Neelsville Presbyterian Church or at an event location.

Agree

COVID-19 and Wellness Guidelines

- If you have been exposed to someone with COVID-19 in the last 14 days or you are experiencing symptoms, please do not attend unless fully vaccinated.
- Do not attend if you have a temperature above 100.4F or illness symptoms.

Please type your first and last name as the person who completed this form. This serves as your digital signature.

Description

Please fill out this form and click submit for each of your children in 6th through 12th grade.

Student Ministry Registration

Description

Please Fix the Following