RBC Student Ministries Registration 2021-2022
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, 2021 - August 30, 2022.

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.

In light of the current COVID-19 pandemic, for the security of your child and our leaders, the following safety guidelines will be followed at Rutherford Bible Chapel:
1) Masks will be required for all students and leaders when indoors and optional when outdoors.
2) General supplies for each student will be prepared in labeled Ziploc bags that are only to be used by that student.
3) Before and after using any shared supplies or game equipment, children will be required to wash hands or use hand sanitizer.
4) Rutherford Bible Chapel Student Ministries will take every effort to adhere to local, State, and Federal guidelines for in person meetings. In the event that any of our guidelines changes, parents will be informed via email of any changes made to these guidelines.

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Last Name of Child *
First Name of Child *
Date of Birth *
MM
/
DD
/
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 *
Consent To Use Online Platforms *
Consent For Communication With Minor (for teens in 7th to 12th Grades)
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If sending your child in for In-Person Student Ministries at Rutherford Bible Chapel: I acknowledge that many of the activities during in-person RBC Student Ministries come with inherent risks. By allowing my child to participate in Student Ministries at Rutherford Bible Chapel, I understand, accept and assume these risks. I hereby waive, release and hold harmless Rutherford Bible Chapel, its employees, and all adult and youth volunteers from all liability, damages, injuries, claims, demands and causes of action my child and/or family member may have arising out of participation in RBC Student Ministries, including but not limited to the risks of exposure to COVID-19, the possible need to quarantine due to exposure to COVID-19, a positive COVID-19 test due to exposure at RBC Student Ministries, and any other COVID-19 related medical issue that may arise. *
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 or any household family member has tested positive for Covid-19, is required to quarantine due to a previous known exposure, 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. *
If sending your child in for In-Person Student Ministries at Rutherford Bible Chapel: I acknowledge that in the event my child tests positive for Covid-19 and has been present for In-Person Student Ministries the week prior to a positive test, that I will inform Elizabeth Rynd, Coordinator of Student Ministries at Rutherford Bible Chapel, immediately about the positive test result, so risk of exposure can be determined and necessary contact tracing can take place. *
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
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