RBC Student Ministries Registration 2022-2023

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Please fill out a separate form for each child. At the end of the form, you can check the boxes for all the student ministries that you are registering your child for. The consents on this form will be effective from September 1, 2022 - August 30, 2023.

Privacy Policy: For the security of your personal information, the information you share will be password protected and will not be made available to third parties.

Please Note: In light of the current COVID-19 pandemic, for the health of your child and our leaders, we ask that any child or leader who exhibits flu-like symptoms or who has tested positive for COVID-19 refrain from participating until symptoms have gone away. If a child or leader shows flu-like symptoms while participating in one of our Student Ministry programs, they will be sent home immediately.

Last Name of Child *

First Name of Child *

Date of Birth *

YYYY

Age of Child *

Grade at School *

Parent(s) Name(s) *

Home Street Address *

Home City *

Home Zip Code *

Parent(s) E-mail Address *

Parent(s) Cell Phone Number *

Please list any allergies or physical restrictions

Photo Release: Please indicate whether or not you will allow your child's photo to be used in print or internet promotions for Rutherford Bible Chapel, including social media sites like Facebook or Instagram *

Yes, I allow my child's photo to be used in print or internet promotions for Rutherford Bible Chapel

No, I do not allow my child's photo to be used in print or internet promotions for Rutherford Bible Chapel

Consent For Communication With Minor (for teens in 7th to 12th Grades)

I allow the group leaders of the ministry for which I check off below to communicate directly with my child via text or e-mail.

I DO NOT allow the group leaders of the ministry for which I check off below to communicate directly with my child via text or e-mail.

Clear selection

If sending your child in for In-Person Student Ministries at Rutherford Bible Chapel: I acknowledge that I will refrain from sending my child to attend In-Person Student Ministries at Rutherford Bible Chapel if he/she has tested positive for Covid-19 or has a fever (100.4 degrees or higher), has a cough, has flu-like symptoms, or has lost the sense of taste or smell. I will not send my child back in for In-Person Student Ministries until he/she has been medically cleared, has had a negative Covid test, or has completed any recommended quarantine time. *

Please click here to acknowledge the above statement

N/A: I will not be sending my child for In-Person Student Ministries at this time.