Children/Youth Program Registration Form 2021-2022

Please fill out this form and click submit.
This form is required annually and must be completed for each child/student. There is a section to select all programs that the child/student will be a part of. This will eliminate the need to fill out a form for each program. We are excited to partner with you through the ministries here at Chisholm Baptist Church.
Student Info

 
Please select all that apply.
 
 
 
 
Please select one option.
Please select one option.
 
 
 
Allergies

Please select all that apply.
 
Medical Concerns

Please select all that apply.
 
Program Selection

Please select ALL programs that you are registering your child/youth for during the 2021-22 school year.
Please select all that apply.
Parent Info

 
 
 
 
 
 
Emergency Contact

This should be someone in addition to a parent or guardian that can be contacted in the event of an emergency when the parent or guardian cannot be reached.
 
 
Photo Release

I grant to Chisholm Baptist Church the right to take photographs of me and my family in connection with the above-identified event(s). I authorize Chisholm Baptist Church, its assigns and transferees to copyright, use, and publish the same in print and/or electronically.


I agree that Chisholm Baptist Church may use such photographs of me with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.

Essentially, "Is it ok if your kid has their photo taken and we put it on our Facebook page, or because they are so cute, we use it for a flyer or on our website to promote our programs?" We will never write names without specific parental permission.

Please select all that apply.
Communicable Disease Waiver

We at Chisholm Baptist Church take your child's safety very seriously. We want to make sure you are aware that any time children are together in groups, there is a chance for your child to be exposed to COVID-19 or other communicable diseases. By checking this, you are acknowledging and are accepting the exposure risk of sending your child to attend Chisholm Baptist child/youth programs. You must select "Yes" for your child to attend.
Please select all that apply.
Permission

I give my child permission to attend the Chisholm Baptist children/youth program(s). Please sign by writing your initials.
 

Description

Please fill out this form and click submit.