Engage Youth Ministry 2022-2023 Registration

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Please fill out the form below to register your child for Engage youth ministry at River Valley Church for the 2022-2023 school year. Please fill out one form for each student, so we can keep their information separated. Please be sure to review and sign the COVID-19 release statement at the bottom of the form. Thanks!

Student's Name *

Student's Birth Date *

YYYY

Student's Age *

Student's Grade This Year *

Parent's Name *

Address *

Parent's phone number *

Do You Text? *

Yes

Parent Email

Emergency Contact Name *

Emergency Contact Phone Number *

Special Needs/Allergies/Helpful Information *

Church You Attend (if none, please write N/A) *

Photo & Video Release Statement

The undersigned parent or legal guardian grants permission for the said child’s pictures to be taken at youth group and/or River Valley Church of Christ's sponsored events on or outside of church property, which can be used on the church website (www.rivervalley.live), social media accounts, and promotional materials.

COVID Release Statement

Please read and review the following COVID release statement and complete registration by filling out the signature form:

Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), River Valley Church is taking extra precautions and enhanced sanitation/disinfecting procedures in compliance with CDC guidance.

Symptoms of COVID-19 include:
• Fever
• Fatigue
• Dry Cough
• Difficulty Breathing

I agree to the following:
• I understand the above symptoms and affirm that my child, as well as all household members, does not currently have, nor have experienced the symptoms listed above within the last 14 days.
• I affirm that my child, as well as all household members, has not been diagnosed with COVID-19 within the past 30 days.
• I affirm that my child, as well as all household members, has not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days.
• I affirm that my child, as well as all household members, has not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days.
• I understand that River Valley Church of Christ cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

By signing below, I agree to each statement above and release River Valley Church of Christ, its staff and volunteers from any and all liability for unintentional exposure or harm due to COVID-19.

Sign By Typing Your Name Below *

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