CHILD INFORMATION
Please provide your child's information. Note: Once you complete this form for your student, you will see a link at the bottom of the conifmration page to rsvp another student.
HEALTH INFORMATION
Allergies: (Medication, Food, Insect, Etc) Ex: Penicillin, Seafood, or None
Conditions / Special Needs: (Other Medical or Behavioral Conditions)? Ex: Asthma, ADHD, Autistic, or None
Current Medications: (List Current Medications) Ex: Albuterol, Flonase, Ceterizine, or None
Additional Notes: Is there anything additional that we should know about your child? Ex: Sensitivity to Strobe Lights, Short Temper, or None
ADDITIONAL INFORMATION
Please share with us some a little more background information and some of your child's favorites and interests... Such as: What hobbies/activities/sports does your child participate in or enjoy? Also, please share your child's homeroom teacher and bus number.
PARENT/GUARDIAN INFORMATION
Please share with us the primary parent/guardian contact from your household and, if applicable, a secondary parent/guardian contact from your household.
EMERGENCY CONTACT INFORMATION
Please provide an emergency contact for your child if we cannot reach you or a second parent/guardian as stated above.
ACKNOWLEDGMENTS
Release Acknowledgement: It is our great pleasure to serve our community and to have your child(ren)/minor(s) participate in our gatherings and events! We do make effort to provide safe and appropriate environments. That said, we all understand that accidents do happen and unforeseen incidents do occur. Thus, it is our reminder to you that your signature will completely and unconditionally indemnify, hold harmless, and release First Church of Bellevue and its agents, employees, volunteers, and persons from any and all liability cause by negligence of First Church of Bellevue and said persons or behaviors of child/minor for personal injuries, property damage, or wrongful death, in the participation of First Church of Bellevue related events.
Photo / Video Consent: By my electronic signature below, I authorize the use of video and/or images of the above child(ren)/minor(s) for social media posts and/or other visual material of First Church.
Support Consent: By my electronic signature below, I give permission for communication with Bellevue Elementary School Administration and Staff about supports that would help my child be successful at GLOW.
Electronic Signature: I consent to the signing of this release form by an electronic signature.
