Event Registration

This form may be filled out for multiple children in the same family if attending the same ministry event. If that is the case, please simply separate names with a comma and include gender, birthdate, grade, and school for additional children in "Name" box. Thank you.

Child Information
Name of Participant(s) *
Name of Participant(s)
Gender *
Birthdate *
Birthdate
Home Phone Number (with area code) *
Home Phone Number (with area code)
Student Cell Phone Number (if applicable)
Student Cell Phone Number (if applicable)
Home Address *
Home Address
Parent/Guardian Information
Name *
Name
Home Phone Number (with area code)
Home Phone Number (with area code)
Cell Phone Number (with area code) *
Cell Phone Number (with area code)
Home Address (if same as above, write "same")
Home Address (if same as above, write "same")
Emergency Information
Health Insurance Telephone Number
Health Insurance Telephone Number
Please Note: All medications need to be specifically identified and may only be administered under the supervision of volunteers with express permission of parents during overnight events.
Emergency Contact (Other than parent or guardian) *
Emergency Contact (Other than parent or guardian)
Emergency Contact Telephone Number *
Emergency Contact Telephone Number
Release and Authorization
Please note that if you would prefer to sign this physically rather than electronically, you have that option, but in order for your child(ren) to participate, we must have a Release and Authorization Form on file.
Please read thoroughly and sign electronically below
The student listed above (Section 2), has my/our permission to participate in the ministry event listed above (Section 1), which is sponsored by Clear Lake Evangelical Free Church (CLEFC). This consent form gives permission to seek whatever medical attention is deemed necessary, and releases CLEFC and its staff from any liability against personal losses of named child(ren). CLEFC does not carry medical insurance for injuries or illnesses sustained in its programs. Please review your personal insurance policy for coverages.
I/We the undersigned have legal custody of the child(ren) named above, a minor, and have given our consent for him/her to attend this event being organized by CLEFC. I/We understand that there are inherent risks involved in any ministry, and I/we hereby release CLEFC, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by CLEFC, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the child(ren) named above. I/we also agree to bring my/our child(ren) home at my/our own expense should they become ill or if deemed necessary by any ministry staff for medical or disciplinary reasons.
I/We also agree to the following: 1. The ministry leaders and pastors of CLEFC stand in our stead in directing and protecting our child(ren) during any ministry event that this consent applies to and that our child(ren) should comply with all reasonable and lawful requests. 2. A person aged 21 years or over will be available to pick up our child(ren) at the time and location specified for pick up. 3. Any friend that our child(ren) wishes to bring on a CLEFC ministry event will need to complete and submit their own registration form in advance of the event. 4. I allow my child’s picture to be used by CLEFC ministry for various needs such as the newsletter, social media, and website.
Printed Name of Parent/Guardian for e-signature *
Printed Name of Parent/Guardian for e-signature
Date signed and submitted *
Date signed and submitted