CLC 2021-22 Medical/Release & Student Registration

To register your student for clubs/groups
1 - Complete student information
2 - Read & sign permissions
3 - Select t-shirt size & clubs/groups
4 - Payment total & method
5 - Click "Submit"
For help or to use your Family Account funds contact the church office.
Thank you!
920.892.4080
church@christianlifefamily.com
 
 
 
 
 
 
 
 
 
Please carefully read the following Activity, Photo, Medical, & Liability Release & Permissions:

ACTIVITY PERMISSION: As parent/legal guardian of the minor identified above my permission is granted to participate in the organized activities of Christian Life Church, except for any modifications identified.

PHOTO RELEASE: Christian Life Church is authorized to use the likeness of my student listed above, in photographs/videos, in publications, and media of 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 my student listed above, receives any medical attention or treatment deemed necessary. Therefore, as the parent(s)/guardian(s) of this listed student, permission is given to and held harmless for any hospital, doctor, and/or health care provider to transport, treat, and/or admit them for care. In the event that I/we are not present at the time of the emergency, the care of the listed student 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 identified above, 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 the minor listed above while participating in any Christian Life Church sponsored or related function or activity.

PERMISSION & LIABILITY RELEASE DECLARATION: As parent/legal guardian of the minor identified above 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 AS PARENT/GUARDIAN IN THIS FORM, SELECTING THE ELECTRONIC SIGNATURE ACKNOWLEGEMENT, ENTERING DATE, & 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 NAMED IN THIS FORM.
Please select one option.
 

Please select one option.
The cost of the following required items are INCLUDED with registration:
..pre-school boys + girls award vests
..5K-12th grade girls award sashes
..5K-12th boys award vest
..5K-12th grade boys Ranger club t-shirt*
NOTE:
..the club t-shirt for pre-school boys + girls & 5K-12th grade girls is an optional extra purchase
..*5K-12th grade boys who already have their RR club t-shirt may choose the alternate white RR emblem t-shirt *in place of the club t-shirt

..Christian Life Youth group will not receive t-shirts for fall registration

Please select one option.
Please select all that apply.
Next, add the cost for each item selected above and TYPE the amount due for this student in the first box below. 
Then, select your method of payment from the second box.
Note:
..To use your Family Account funds FIRST contact the church office 920.892.4080.
 
 
Please select all that apply.
Please click the green "Submit" button below. You will then be directed to our confirmation page which will
...contain a link to our online payment portal option and
..allow you to register another child by clicking the "Return to Form" button at the bottom of the confirmation page.
Please check your email inbox for a confirmation message. 
If you have any questions or concerns please contact the church office 920.892.4080.
Thank you!

Description

To register your student for clubs/groups
1 - Complete student information
2 - Read & sign permissions
3 - Select t-shirt size & clubs/groups
4 - Payment total & method
5 - Click "Submit"
For help or to use your Family Account funds contact the church office.
Thank you!
920.892.4080
church@christianlifefamily.com