Student Registration

Great Oak Church | 4:12 Student Ministry & GO Kids Ministry

2023/2024 School Year
This form will be used for Sunday School, Youth Group activities, Camp, etc.

Parent/Guardian Full Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Phone Number

Parent/Guardian Full Name

Phone Number

Email Address

First Name (Child 1)

Last Name

Birthdate (Child 1)

Age/Grade (Select One)

First Name (Child 2)

Last Name

Birthdate (Child 2)

Age/Grade (Select One)

First Name (Child 3)

Last Name

Birthdate (Child 3)

Age/Grade (Select One)

First Name (Child 4)

Last Name

Birthdate (Child 4)

Age/Grade (Select One)

First Name (Child 5)

Last Name

Birthdate (Child 5)

Age/Grade (Select One)

Allergies (list with child's name)

Acknowledgement
I/We acknowledge that I/we are the parent or legal guardian of the minor(s) listed.

Permission
I/we give permission to my/our child to attend and participate in activities sponsored by Great Oak Church (GOC).

Medical Authorization
Should my/our child become ill or injured during a GOC sponsored event, I/we authorize the group leaders/authorized personnel, in whose care the minor has been entrusted to rely on the advice of licensed medical physicians(s) and/or dentist(s), and in reliance on this medical/dental judgment to consent to any and all necessary medical and/or dental treatment, which may include x-rays, diagnostic/radiological tests, administration of medications and/or anesthesia, surgical intervention, and/or hospitalization. I/We shall be liable and agree to pay all costs and expenses incurred in the connection with such authorization. Should it be necessary for my/our child to be transported by an authorized emergency medical vehicle due to medical reasons or otherwise, I/we shall assume all costs and expenses related to such transportation and related emergency medical treatment.

Release
I/We do hereby release GOC and all associated parties including cooperating churches and trained personnel of liability in the case of injury to any participants in the programs provided by GOC. GOC cannot and should not be held responsible for a minor’s conduct that violates rules established by GOC to protect him/her from harm or injury. Should my/our minor child violate any of GOC’s rules, policies, or procedures or behave in a manner inconsistent with GOC’s mission and philosophy while participating in the GOC sponsored event, I/we acknowledge that said minor child may be sent home at my/our expense. Registration and participation grants GOC permission to use photos taken during programming, which may include my/our child, for advertising and promotional purposes without my consent. This release covers all GOC sponsored events/programs in which my/our child participates.

Submit

For additional children, please fill out another form.

Student Registration

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