Oakridge Student Ministries Registration Form

• Parent/Guardian Information
• Name
  First Name

  Last Name
• Relationship to Student(s)
• Phone Number
   

  (###)

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• Email Address
   
• Additional Parent/Guardian Name
  First Name

  Last Name
• Relationship to Student(s)
• Phone Number
   

  (###)

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• Email Address
   
• Address
  Street Address

  Address Line 2

  City

  Province / State / Region

  Postal Code / Zip

  Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

  Country
• First Student
• First Name

  Last Name
• Birthday
  MM

  /

  DD

  /

  YYYY
• Grade
  >6789101112
• School
• Cell Phone Number
   

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• Email Address
   
• Instagram Handle
• Allergies
• Medical Information
• Second Student
• First Name

  Last Name
• Birthday
  MM

  /

  DD

  /

  YYYY
• Grade
  >6789101112
• School
• Cell Phone Number
   

  (###)

  -

  ###

  -

  ####
• Email Address
   
• Instagram Handle
• Allergies
• Medical Information
• Third Student
• First Name

  Last Name
• Birthday
  MM

  /

  DD

  /

  YYYY
• Grade
  >6789101112
• School
• Cell Phone Number
   

  (###)

  -

  ###

  -

  ####
• Email Address
   
• Instagram Handle
• Allergies
• Medical Information
• Fourth Child
• First Name

  Last Name
• Date
  MM

  /

  DD

  /

  YYYY
• Grade
  >6789101112
• School
• Cell Phone Number
   

  (###)

  -

  ###

  -

  ####
• Email Address
   
• Instagram Handle
• Allergies
• Medical Information
• Legal Stuff
• By registering and permitting my child to attend youth at Oakridge Presbyterian Church. I hereby release and hold harmless, OPC, its officers , employees, volunteers and members of Session from all claims and causes of action by reason of any injury which may be sustained as a result of this activity, whether on Church premises or on the way to or from, or while at the event.
• In the event of a medical emergency, and I cannot be reached, I give OPC staff and/or volunteers permission to seek medical attention for my child. I give permision to the physician, paramedic, nurse or dentist selected by OPC to provide medical or dental aid for illness or injury including transportation to and from facilities. I agree to bear all costs associated with any emergency care and resulting transportation.
• I give OPC permission to use photos of my child(ren) for church slideshows, newsletters, website, and promotional material.
  Yes

  No
• Parent/Guardian Signature