General 1 — Northridge Church

Registration Form

Please fill out the information below. If you are only registering one student, skip “Multiple Student Registration” and continue in “Parental Permission”. Upon completion, you can hit “Submit” and you will not be asked for payment.

How many students are you registering for this event?

If you're registering only one student, please give the name, grade and shirt size (if applicable for this retreat) then feel free to skip to the "Parental Permission" section.

Name of Student

First Name

Last Name

Current Grade of Student

Multiple Student Registration

Name of Student #2

First Name

Last Name

Current Grade of Student #2

Name of Student #3

First Name

Last Name

Current Grade of Student #3

Name of Student #4

First Name

Last Name

Current Grade of Student #4

Parental Permission

Does your child have any food allergies?

Explanation of Allergy:

Does your child have any medication that needs to be administered?

Explanation of Medication:

Name of Parent/Guardian

First Name

Last Name

Parental Permission Agreement

I understand that Northridge Church does not assume liability for any injury sustained with this program or any medical expenses incurred therein. I also hereby, as parent/guardian of the specified students, give permission for them to attend this event. I understand that lack of compliance with NYM instructions during this event could result in forfeit of future trip opportunities.

Yes

By inputting the date below, you are signifying that you are the parent/guardian listed above, and that you have read and understood the above guidelines/restrictions.

YYYY

I have filed a recent and updated NYM General Medical Authorization Form

If you have not, after you have completed this registration, please immediately navigate to the "Registration Details" page under "Events" and download a form, fill it out, and return it to the Info Center at your campus ASAP. We will be contacting you regarding your lack of a Medical Release Form to ensure this is completed.

Yes

I'm not sure (we'll let you know where you stand)

Registration Form

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