CHILD 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.
Sex at Birth
*
Select Option
Male
Female
Grade
*
Select Option
Kindergarten
1
2
3
4
5
Tee Shirt Size
*
Select Option
Youth XS (2-4)
Youth S (6-8)
Youth M (10-12)
Youth L (14-16)
Youth XL (16-18)
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
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
Is your child able to be present for all GLOW dates in this school year?
*
Select Option
Yes
No
Has your child participated in GLOW in prior years?
*
Select Option
Yes
No
Does your child receive regular faith instruction at another point during the week?
*
Select Option
Yes
No
Does your child require additional services to be successful in a classroom environment?
*
Select Option
Yes
No
PARENT/GUARDIAN INFORMATION
EMERGENCY CONTACT INFORMATION
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.
