| First Name* |
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| Last Name* |
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| Gender* |
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| Birthdate* |
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| Age |
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| School |
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| Programs |
What programs will the child participate in?
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| Allergies |
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| Parents or Guardians* |
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| Email |
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| Address |
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| City |
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| State |
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| Zip Code |
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| Phone* |
Your primary contact number
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| Emergency Contact* |
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| Photographic Release* |
(Check the box to agree) I give permission for my child/student to appear in photographs or videos that may be used in flyers, church website, poster, and other promotional activities that Oakdale Park Christian Reformed Church may produce.
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| Cell Phone Device Policy* |
(Check the box to agree) Although this is an electronic age, we at Oakdale Park Church value real face-to-face relationships. In light of this, we ask that students pocket or store their electronic devices during programs they attend at Oakdale Park Church. If a student is unable to keep their device stored away during program time it will be removed from the student until the end of the program.
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| Electronic Signature* |
(Check the box to agree) By submitting this permission/consent form, I, the adult parent/guardian agree to the following: 1) I give permission for my student to participate in any and all activities offered in conjunction with their club/group. 2) I give permission for my student to be transported by a licensed and insured driver to any and all events with their club/group, including any outings and special events. 3) I release Oakdale Park Christian Reformed Church, its partners, staff & volunteers from any liability for injury that my child/student or their possessions may sustain during activities or outings. 4) In case of illness or injury, and in the event that I or the other emergency contacts are able to respond, I authorize Oakdale volunteers and staff to seek out and allow emergency medical or dental treatment or surgery by a licensed physician, dentist, or hospital.
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