EmailMe Form - Taste of SWARM 2021 Registration

Student Name *

DOB *

MM / DD / YYYY

Grade *

School *

Home Address *

Email Address *

Emergency Contact #1 (Name) *

Emergency Contact #1 (Phone) *

### - ### - ####

Emergency Contact #2 (Name) *

Emergency Contact #2 (Phone) *

### - ### - ####

Does your child have special needs or medical conditions? *

Yes

No

If yes, please explain

Please list any medications your child currently taking for the above

Does your child have allergies? *

Yes

No

If yes, please explain

Please list any medications your child currently taking for the above

Please indicate any dietary restrictions and instructions here

T-Shirt Size *

Coming with a friend? Let us know who they are so we get you on the same team!

A taste of Swarm is a flexible event designed to help students get ready for tons of future Student Ministry events in the years to come. As such, students can attend All three days, or just one afternoon. Whatever their schedule allows and they feel comfortable with. Please indicate which days your student plans to attend, and in detail provide times they will be dropped off or picked up if not attending all three days per the normal schedule.

Friday Night (10/1)

Saturday (10/2)

Sunday (10/3)

If not attending all three days, please provide details as to the drop off/pick up times that will work for your student.

Photo Release:

By registering for this event I hereby grant Ginger Creek Community Church and it’s agents permission to photograph and /or video graph my child(ren). The photos may be used in various church media and publications including but not limited to display boards, promotions, newsletters, brochures, worship bulletins, video productions, advertisements, and more.

Medical & Liability Release:

I understand that in the event medical intervention is needed, every attempt will be made to contact the persons listed on this form. In the event I cannot be reached in an emergency, I hereby give permission to the physician, dentist or EMT to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed medically necessary. I understand that my health insurance coverage for my child will provide primary coverage in the event medical treatment or intervention is needed. I agree to allow the identified child to participate in the activity identified above and understand all reasonable safety precautions will be taken at all times by its sponsors, staff and agents. I understand the possibility of unforeseen hazards and know the inherent possibility or risk. I agree not to hold Ginger Creek Community Church, its leaders, employees and volunteer staff liable for any damages, losses, diseases or injuries incurred as a result of the child’s participation in this activity.

Code of Conduct:

I agree to show respect for the leadership of the above mentioned event, the other student participants as well as the property and any policies of the organization where the event is being held. If applicable to the event, I also agree to participate in the buddy or group system for safety issues; meet at the designated check-in times and places; and not exhibit any behavior that would jeopardize the integrity of Ginger Creek Community Church and its affiliates. I understand if my behavior becomes less than what is expected of me, I will be held accountable and possibly be sent home.

Student Signature *

Electronic Signature

Parent/Guardian Signature *

Electronic Signature

Date *

MM / DD / YYYY

After pressing "Submit" we will receive your registration, and you will be redirected to the payment portal. Please note, there is an online processing fee for online credit card payments. Cash and Check are also accepted.