Oakwood GEMS Girls' Club 2022-23 Registration

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One entry per child please! (It makes sorting the spreadsheet so much easier :-) )

Girl's First & Last Name: *

School Grade (Fall 2022) *

Date of Birth: *

YYYY

Parent/Guardian(s) Name(s): *

Street Address: *

City, State, Zip: *

Primary Phone: *

Secondary Phone:

Email Address for club updates and reminders: *

Home Church:

School:

Food allergies:

Other allergies or medical conditions we should be aware of:

Anything else we should know about your girl? (likes/dislikes, personality, etc)

In case of emergency, contact: *

(Different from parent/guardian listed above please)

Emergency contact phone: *

Emergency contact relationship to child: *

Photo Release - Oakwood *

Oakwood GEMS participants may be photographed or video-recorded for use in promotional items related to Oakwood Church, including the church website, postcards and other mailings, and videos shown during the Sunday morning church service. Do you authorize us to use your child's photo for these purposes?

Yes

Other:

Photo Release - GEMS Girls' Clubs *

Oakwood GEMS participants may be photographed or video-recorded for use in promotional items for the larger GEMS Girls' Clubs organization. Do you authorize us to use your child's photo and first name for these purposes?

Yes

Other:

"Signature" and Date *

By filling out this form I give permission for the above named girl to attend Oakwood GEMS Girls' Club for the 2022-23 year. Also, by checking the above boxes, I hereby release Oakwood GEMS Girls' Club from all claims and liabilities arising out of the use of these photos and videos. I also understand that this consent will remain in effect for the entire 2022-2023 GEMS club year, until a written request to revoke consent is received by the club. If you agree, please type your name and today's date here.

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