RUSH STUDENT REGISTRATION (Manitowoc) • Crossroads Community Church

This "RUSH Student Registration" form should be completed by parent/guardian. Thank you!

STUDENT Information

Student First Name *

Student Last Name *

Mobile Number

Email Address

Gender *

Date of Birth *

School Grade *

School Name *

Allergies (please list any food or environmental allergies that we should be aware of)

RUSH Student Church Affiliation *

RUSH Student Other Church Name (if applicable)

Home Address Of Student

Home Address *

Home City *

Home State *

Home Zip Code *

Parent/Guardian Information

Mother's First Name

Mother's Last Name

Mother's Phone Number

Mother's Email Address

Father's First Name

Father's Last Name

Father's Phone Number

Father's Email Address

Important: Parental/Guardian Consent Forms

The following information is required in order to process this registration form. We ask that parent/guardian read through each waiver, and choose the appropriate response. Thank you!

I am the parent/guardian and I have the legal authority to sign these waivers and permissions for the student(s) that is being registered for RUSH. (PARENT/GUARDIAN-please type your name in the line below.)

COVID Waiver

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person, the government has set recommendations, guidelines, and some prohibitions which Crossroads Community Church/RUSH Youth Group adheres to comply. In consideration of my students participation RUSH Youth Group, I, the legal parent/guardian of this student, acknowledge and agree to the following:

I recognize that my students participation in RUSH Youth Group has the possibility of putting he/she at risk of contracting COVID-19. I also understand that RUSH Youth Group will not be policing social distancing and that social distancing will be the responsibility of the student to follow or not follow. With full knowledge of the risks involved, I hereby release, waive, discharge Crossroads Community Church/RUSH Youth Group staff and volunteers from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by my student related to COVID-19 while participating in any activity while in, on, or around RUSH Youth Group or while using the meeting facilities that may lead to unintentional exposure or harm due to COVID-19.

This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.

RUSH COVID Release Waiver *

Medical Waiver

The student(s) listed on this form has/have my permission to participate in all RUSH Youth Group activities and events organized and/or hosted by Crossroads Community Church. This consent form gives permission to seek whatever medical attention is deemed necessary, and releases Crossroads Community Church and its staff and/or volunteers of any liability against personal losses of myself/named child. I understand that my consent/permission is granted for the entire duration of time that my child(ren) participates in RUSH youth group activities.

I/We have legal custody of the participant(s) named on this form, a minor(s), and have given our consent for him/her/them to participate in all RUSH Youth Group activities being organized by Crossroads Community Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release Crossroads Community Church, its 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 our child(ren)s involvement. In the event that he/she/they are injured and require 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 Crossroads Community Church, 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.

RUSH Student Medical Waiver *

Medical waiver permission is granted.

Permission To Transport Off-Site

With advance notice from a RUSH leader and/or volunteer parent, I hereby grant permission to Crossroads Community Church (including but not limited to RUSH leaders and/or volunteer parents) to transport my child(ren) off-site for activities such as but not limited to Scatter Nights, service projects, small group gatherings and/or leader/student meetings. I understand that my permission is granted for the entire duration of time that my child(ren) participates in RUSH youth group activities.

RUSH Student Off-Site Permission *

Media Release

I hereby grant permission to Crossroads Community Church & RUSH Youth Group to us my child(ren)s photo on their website(s) or in any other official publications, promotional materials and videos, and I acknowledge Crossroads Community Churchs right to crop or treat the photo at their discretion. I also understand that once the image is posted on a website, Facebook or newsletter, the image can be downloaded. Therefore, I agree that Crossroads Community Church is not held responsible for such occurrences. I understand that my permission is granted for the entire duration of time that my child(ren) participates in RUSH youth group activities.

RUSH Student Media Release *

Ibuprofen & Tylenol

Periodically students ask for ibuprofen and/or Tylenol. Do you give Crossroads Community Church (RUSH leaders and/or volunteer parents) permission to give your child(ren) Ibuprofen or Tylenol if they request it?

RUSH Student Permission for Ibuprofen &Tylenol *

By checking this box, you are verifying that I (parent/guardian) understand, agree and personally give my consent to all these waivers. *

Is there any other info you want to share that would be helpful for us to know?