Elevate Youth Group Registration & Consent Form

Grades 7–12

Hi there! We’re so glad you’re signing up your student for Elevate Youth. We can’t wait to connect with them this year!

We meet every Tuesday from 6:30 PM to 8:30 PM. Parent's please pick up your student on time. We love them so much, but sleep matters.

Please fill out this form in its entirety.

If you have any questions, please email Patrice Rhoton at patrice.rhoton@rcaz.us

Thanks so much for helping us keep everything accurate, up to date, safe, and running smoothly. We're looking forward to a great year with your student!

— The Elevate Youth Team

Your name *

Email address *

Phone number *

Address *

What is your students First and Last Name? *

Students Gender: *

Students Birthday: *

Students Grade: *

Students School: *

What is your students favorite sweet treat? *

At Elevate youth group, we like to celebrate the youth, especially on their birthdays!

Does your student have any hobbies or interests? Please list below. *

What is your students favorite color? *

Parent/Guardian First and Last Name: *

Phone Number: *

Secondary Parent/Guardian Name (optional)

Phone Number

Emergency Contact other than parent/guardian First and Last Name: *

Phone Number *

Relationship to student: *

Medical: *

Please provide any Information on the Student's Medical Conditions, Allergies, or Special Needs, if applicable. If none, type NA

Medication: *

Please list any medicine that your student may need to take during Tuesday night group and or youth events. If none, please write NA

Insurance: *

Does the student have medical Insurance?

Yes

If Yes please provide the name of the provider, the policy holders name, as well as the policy number.

Transportation & Participation Consent *

I give permission for my child to attend and participate in Elevate Youth events, including off-site events where transportation may be provided by Elevate Youth Ministry or theCHURCH.

Yes

Photo & Media Release *

I authorize Elevate Youth and theCHURCH to take and use photos and/or videos of my child for church communication, social media, and promotional purposes. Photos will only be taken by approved communications leaders and will never be shared or posted by volunteers/leaders from personal accounts.

Yes

Liability & Medical Release *

I, the parent/guardian, understand that all reasonable safety precautions will be taken at all times by the leaders of Elevate Youth. I understand the possibility of unforeseen hazards and know the inherent risk involved. I agree not to hold theCHURCH, its leaders, volunteers, staff, or affiliates liable for damages, losses, diseases, or injuries incurred by the subject of this form.

In the event of an emergency, I give permission to the adult leaders of Elevate Youth to secure proper medical treatment for my child as needed.

Yes

Signature: *

Todays Date: *

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