2019/2020 Student Registration for Christian Life Church, Plymouth, WI

Use this form to register students.
If you have questions or if you want to use your
Family Account funds - contact the church office BEFORE you begin.
Thank you!
920.892.4080
church@christianlifefamily.com
There are FIVE Steps to register up to FIVE students.
1 - Complete Parent Guardian information
2 - Complete Emergency Contact information
3 - Complete Student Registration 
4 - Complete Release & Permissions with Electronic Signature
5 - Payment 

To use your Family Account contact the church office 920.892.4080
Step 1 - Complete Parent/Guardian Contact Information (Primary Contact)

Please note:

Parent/Guardian 1 is our main contact for the student(s) registered on this form.


Parent/Guardian 1 will receive all student related communications.
 
 
 
 
 
Please select one option.
Parent/Guardian 2 Contact Information (Secondary Contact)

Parent/Guardian 2 will only be contacted with student related information if the option is selected below.
 
 
 
 
Please select one option.
Please select one option.
Step 2 - Complete Emergency Contact & Optional Caregiver Information

Please enter AT LEAST ONE person other than the Parent(s)/Guardian(s) listed above as an EMERGENCY CONTACT in the event we are not able to contact you directly by phone in an emergency.
 
 
If applicable, list the name(s) and phone number(s) of any caregiver with whom your student(s) may arrive or depart from our activities with on a regular basis
 
 
Step 3 - Complete Student Registration(s)

DIRECTIONS:


Begin with Student 1


Enter the full name, birthdate, school grade, t-shirt size, and if applicable, any medical info (allergies, etc.) for the student(s) you are registering.


Each student's t-shirt size is required for sashes, vests & t-shirts and cost is included with the registration fee. Refer to size chart below. EXCEPTION: t-shirt is optional for Girls Ministries however SIZE is still required for sashes & vests. Refer to the size chart below.


To register multiple students, continue with Student 2 and so on. If you need to register more than five students in the same family group, please click the green "Return to Form" button on the confirmation page after you submit this current form. Then begin a second registration form. 


Bible Quiz - the Bible Quiz Annual Registration Fee is only offered in the Registration of Student 1, as it applies for the entire family. When registering multiple students in your family for Bible Quiz, please select it for each student participating however, only Student 1 will carry the Registration Fee.


After all students you intend to register are entered, move on to Step 4 - Release & Permission section.

Student 1 Information & Registration

 
 
Please select one option.
Please select one option.
If applicable, in the box below, please make us aware of any known allergies, required prescribed medications, or chronic conditions which may require Student 1's participation in certain activities to be modified.
 
 
 
 
Select the club/group(s) Student 1 is registering for ONLY. Additional students should register under Student 2, Student 3, and so on.


Next, select the "Annual Registration Fee" drop down which corresponds with the Student 1 club/group selection(s). Club t-shirts are an optional purchase for Girls Ministries.


Note: It is possible for students to be a part of more than one club/group at a time, for instance, a student in 6-12th grades may register for Christian Life Youth* AND a girls or boys club &/or Bible Quiz**; a younger student may register for Bible Quiz &/or a girls or boys club.


*There is no Registration Fee or t-shirt option for Christian Life Youth - the total for this option will be $0.00.
** Bible Quiz Annual Registration Fee is only offered in Registration of Student 1 as it applies for the entire family.
Please select all that apply.
 
Please select all that apply.
Student 2 Information & Registration

 
 
Please select one option.
Please select one option.
If applicable, in the box below, please make us aware of any known allergies, required prescribed medications, or chronic conditions which may require Student 2's participation in certain activities to be modified.
 
 
 
 
Select the club/group(s) Student 2 is registering for ONLY. Additional students should register under Student 3,  Student 4, and so on.


Next, select the "Annual Registration Fee" drop down which corresponds with the Student 2 club/group selection(s). Club t-shirts are an optional purchase for Girls Ministries.


Note: It is possible for students to be a part of more than one club/group at a time, for instance, a student in 6-12th grades may register for Christian Life Youth* AND a girls or boys club &/or Bible Quiz**; a younger student may register for Bible Quiz &/or a girls or boys club.


*There is no Registration Fee or t-shirt option for Christian Life Youth - the total for this option will be $0.00.

** Bible Quiz Annual Registration Fee is only offered in Registration of Student 1 as it applies for the entire family.
Please select all that apply.
 
Please select all that apply.
Student 3 Information & Registration

 
 
Please select one option.
Please select one option.
If applicable, in the box below, please make us aware of any known allergies, required prescribed medications, or chronic conditions which may require Student 2's participation in certain activities to be modified.
 
 
 
 
Select the club/group(s) Student 3 is registering for ONLY. Additional students should register under Student 4, Student 5.

Next, select the "Annual Registration Fee" drop down which corresponds with Student 3 selection(s). Club t-shirts are an optional purchase for Girls Ministries.

Note: It is possible for students to be a part of more than one club/group at a time, for instance, a student in 6-12th grades may register for Christian Life Youth* AND a girls or boys club &/or Bible Quiz**; a younger student may register for Bible Quiz &/or a girls or boys club.

*There is no Registration Fee or t-shirt option for Christian Life Youth - the total for this option will be $0.00.

** Bible Quiz Annual Registration Fee is only offered in Registration of Student 1 as it applies for the entire family.

Please select all that apply.
 
Please select all that apply.
Student 4 Information & Registration

 
 
Please select one option.
Please select one option.
If applicable, in the box below, please make us aware of any known allergies, required prescribed medications, or chronic conditions which may require Student 4's participation in certain activities to be modified.
 
 
 
 
Select the club/group(s) Student 4 is registering for ONLY. An additional student should register under Student 5.

Next, select the "Annual Registration Fee" drop down which corresponds with Student 4 selection(s). Club t-shirts are an optional purchase for Girls Ministries.

Note: It is possible for students to be a part of more than one club/group at a time, for instance, a student in 6-12th grades may register for Christian Life Youth* AND a girls or boys club &/or Bible Quiz**; a younger student may register for Bible Quiz &/or a girls or boys club.

*There is no Registration Fee or t-shirt option for Christian Life Youth - the total for this option will be $0.00.

** Bible Quiz Annual Registration Fee is only offered in Registration of Student 1 as it applies for the entire family.

Please select all that apply.
 
Please select all that apply.
Student 5 Information & Registration

 
 
Please select one option.
Please select one option.
If applicable, in the box below, please make us aware of any known allergies, required prescribed medications, or chronic conditions which may require Student 5's participation in certain activities to be modified.
 
 
 
 
Note: If you need to register more than five students in the same family group, please click the green "Return to Form" button on the confirmation page after you submit this current form and begin the next registration. Contact the church office if you need help 920.892.4080.



Select the club/group(s) Student 5 is registering for ONLY. Additional students should register by beginning a new registration form after this one is submitted.

Next, select the "Annual Registration Fee" drop down which corresponds with Student 5 selection(s). Club t-shirts are an optional purchase for Girls Ministries.

Note: It is possible for students to be a part of more than one club/group at a time, for instance, a student in 6-12th grades may register for Christian Life Youth* AND a girls or boys club &/or Bible Quiz**; a younger student may register for Bible Quiz &/or a girls or boys club.

*There is no Registration Fee or t-shirt option for Christian Life Youth - the total for this option will be $0.00.

** Bible Quiz Annual Registration Fee is only offered in Registration of Student 1 as it applies for the entire family.


Please select all that apply.
 
Please select all that apply.
Step 4 - Release & Permissions

Please carefully read the following Activity, Photo, Medical, & Liability Release & Permissions:


ACTIVITY PERMISSION As parent/legal guardian of the minor identified above as Student(s) 1, 2, 3, 4, 5, permission is granted for Student(s) 1, 2, 3, 4, 5, to participate in the organized activities of Christian Life Church, except for any modifications identified in the Awareness List for Student(s) 1, 2, 3, 4, 5.


PHOTO RELEASE Christian Life Church is authorized to use the likeness of Student(s) 1, 2, 3, 4, 5, in photographs/videos in publications and media Christian Life Church without any monetary claim for the use thereof.


MEDICAL TREATMENT PERMISSION & LIABILITY RELEASE In the event of sickness, injury or other medical emergency, it is requested that Student(s) 1, 2, 3, 4, 5, receive any medical attention or treatment deemed necessary. Therefore, as the parent(s)/guardian(s) of Student(s) 1, 2, 3, 4, 5, permission is given to and held harmless for any hospital, doctor, and/or health care provider to transport, treat, and/or admit Student(s) 1, 2, 3, 4, 5, for care. In the event that I/we are not present at the time of the emergency, the care of Student(s) 1, 2, 3, 4, 5, has been entrusted to the staff and designated youth leader of Christian Life Church, Plymouth, WI while attending any church sponsored or related function or activity both on and off church grounds.


CLC LIABILITY RELEASE DECLARATION As parent/legal guardian of the minor(s) identified above as Student(s) 1, 2, 3, 4, 5, I declare that Christian Life Church, its agents, assigns, staff, employees and volunteer workers are released from any liability whatsoever arising out of property damage or loss as well as any injury, sickness or death which may be sustained by Student(s) 1, 2, 3, 4, 5, while participating in any Christian Life Church sponsored or related function or activity.

PERMISSION & LIABILITY RELEASE DECLARATION As parent/legal guardian of the minor(s) identified above as Student(s) 1, 2, 3, 4, 5, I declare that an electronically transmitted or photocopy of this electronically signed form on file with Christian Life Church is equally valid as the original version and is verified by my electronic signature.
BY TYPING YOUR NAME, CHECKING THE ELECTRONIC SIGNATURE BOX, & SUBMITTING THIS FORM, YOU ARE INDICATING THAT THE ABOVE LISTED "ACTIVITY PERMISSION, PHOTO RELEASE, MEDICAL TREATMENT PERMISSION & LIABILITY RELEASE, CLC LIABILITY RELEASE, and PERMISSION & LIABILITY RELEASE DECLARATION" IS UNDERSTOOD, AGREED TO, AND ACCEPTED BY YOU, THE PARENT/GUARDIAN NAMED IN THIS FORM, FOR THE STUDENT(S) NAMED IN THIS FORM.
 
Please select all that apply.
 
Step 5 - Payment

Click on the green button below to complete your registration process.

To discuss payment options, please call the church office   
Mon-Fri between 9am & 4pm 920.892.4080
or email us any time

church@christianlifefamily.com
 
 
 
 
 

Description

Use this form to register students.
If you have questions or if you want to use your
Family Account funds - contact the church office BEFORE you begin.
Thank you!
920.892.4080
church@christianlifefamily.com