Summit Students Registration Form For Middle and High School Students attending Summit Students ministries and events. "*" indicates required fields About Your Child(ren)How many students are you registering?*Please enter a number from 1 to 7.Student 1. Name* First Last Gender* Male Female Grade*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeBirthday* Month Day Year Age*Allergies Student 2. Name* First Last Gender* Male Female Grade*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeBirthday* Month Day Year Age*Allergies Student 3. Name* First Last Gender* Male Female Grade*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeBirthday* Month Day Year Age*Allergies Student 4. Name* First Last Gender* Male Female Grade*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeBirthday* Month Day Year Age*Allergies Student 5. Name* First Last Gender* Male Female Grade*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeBirthday* Month Day Year Age*Allergies Student 6. Name* First Last Gender* Male Female Grade*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeBirthday* Month Day Year Age*Allergies Student 7. Name* First Last Gender* Male Female Grade*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeBirthday* Month Day Year Age*Allergies Parent/GuardianParent Name* First Last Parent Phone Number*Parent's Email Address* Other Parent Name First Last Other Parent Phone NumberYour Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Are you a Member of McConnell? Yes No Who is registering the Student(s) today? Your relationship to the student Emergency Contact Name and Phone # May we have permission to photograph your student?* Yes No May we use your student's photo in church media?* Yes No Child Protection & Safety Policy* I agree to the Child Protection & Safety Policy belowCHILD PROTECTION & SAFETY POLICY: In order to provide a safe and secure environment for preschoolers, children, youth and any person over the age of 18 with mental and/or developmental disabilities entrusted to our care, McConnell Baptist Church requires all individuals working with children and students (or other vulnerable populations) to complete online Child Protection & Safety Training though the Ministry Safe website & completion of a background investigation prior to starting ministry work or volunteer placements. This applies to all paid and non-paid church staff and volunteers who supervise or have custody of minors. Out of Control Behavior Addendum to Child Protection & Safety Policy McConnell Baptist Church staff and volunteers must take reasonable actions needed to protect all students from harm. Staff and volunteers may use reasonable physical restraints to break up a fight or other out of control behavior when any student becomes an imminent danger to themselves, or others, and the student(s) do not respond to less intensive interventions. Nothing herein prohibits a staff member or volunteer from defusing a fight or physical altercation.Transportation/church vans* Yes No I give permission for my student(s) to be transported by church-owned vehicles (bus or vans) from Towns County Schools to McConnell Baptist Church for Summit Student Ministry activities on the church campus. Small group leaders may also transport my student(s) by church vans to local restaurants on occasion.Your Comments, Questions or any special information about your student.
