2025 Youth Ministry Registration & Release

Your name *

Email address *

Phone number

Address

Press (+Add Child ) for each Middle and High School Student in your family

Household members

School(s) *

Does your child have any allergies, medical conditions, or limitations we should be aware of? *

Yes

If yes, please specify and give us any information you feel we may need to help in an emergency.

Authorized Guardians for Pick-Up *

For the purposes of safety and preventing kids from potential danger or trouble leaving with friends/unknown parties, we would like to have parents tell us who their child(ren) can be picked up from youth ministry events by. Please list the names and relationship to your child of all parties you consent to allow your child to be picked up from Church of Emmanuel events by below.

I give permission for my student's small group leader(s) to text my child.

These texts will be primarily group texts, with other leaders and students, to share event information, prayer requests and follow up from discussions within small group time. If you give permission, please list your child's phone number below.

Consent

It is understood that there will be activities and recreational equipment at these events that are inherently dangerous. Understanding this, I (on behalf of my family, and any others who might make a claim on my/my child’s behalf) expressly assume any and all risks of property damage, injury, and/or death arising from my/my child’s participation in these events including risk arising from transporting to/from these events. I knowingly release Church of Emmanuel, members of their Governing Board, Elders, Officers, Employees, Members, Volunteers, and Agents (collectively, the Released Parties), from any and all claims, losses, damages, and liabilities (whether known or unknown or unforeseen) related to my/my child’s participation in these events, including release of claims that may arise during transportation to/from these events.
I further agree to indemnify and defend the Released Parties from any and all claims, losses, damages, and liabilities related to any and all property damage, personal injury and/or death arising from my/my child’s participation in these events, as may be asserted by a third party (defined as any party other than the Released Parties or me). In case I am/my child is in need of medical or surgical treatment to protect my/my child’s health and welfare while participating in these events, I authorize and agree to allow any authorized agent or employee of Church of Emmanuel to consent to and authorize the administering of such necessary medical and/or surgical treatment. I authorize the release of my/my child’s medical history by my/his or her primary physician to the treating medical providers in case of emergency in order to care for me/my child. This is in compliance with state and federal HIPPA privacy regulations. I agree that this Agreement shall be governed by and interpreted in accordance with the laws of the State of Massachusetts and the parties hereby agree to the exclusive jurisdiction of the Massachusetts courts. The terms of this Release are contractual and not a mere recital.

Print Name as Signature and Date *

Photo & Video Release *

I also consent for photographs and videos to be taken of my child while engaged in any ministry activities for the purpose of illustrating, promoting, and encouraging participation in the student ministries program and release the Church of Emmanuel of any liability.

Yes, I consent.

No, I do not consent.

Print Name as Signature and Date *

Is there anything else you would like us to know about your child(ren)?

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