GEMS Girls Registration

Check us out on Facebook

Who: girls in 1st-8th grade

What: a relationship building club program for girls

Where: Bridgewater Community Church

When: kickoff Sunday, September 15, 2019 at 6:30pm

Classes are Monday evenings from 6:30-8:00pm, beginning on September 16th.

Register by July 14th! Registration fee is $20/girl. Scholarships are available--please contact the church at (419) 485 8229.

RM_Stats

Child's First Name^*

Child's Last Name^*

Birth date^*

Email^*

School^*

Grade^*

Address^*

City^*

State^*

Zip/Postal Code^*

Home Phone^*

Work Phone

This e-mail belongs to

This will only be used in case of changes to our schedule or occasional reminders

Mother's Name

Cell Phone

Father's Name

Father's Cell Phone

Home Church

Facts concerning your child's medical history including allergies, medicines being taken or any physical impairment

Person(s) authorized to pick up child^*

Person(s) NOT authorized to pick up child

Emergency contact if parent or guardian cannot be reached^*

I am capable of paying the $20 registration fee^*

If you are not able to pay the registration fee, scholarships are available. Please contact the church at (419) 485 8229.

Parents/Guardians: A) In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for adults at BCC to topically wash an open wound, apply a bandage, or provide an ice pack for bumps and bruises. In the event of a serious emergency, I give BCC permission to call 9-1-1 with transport to Community Hospital of Williams County-Bryan. B) I do NOT give my consent for emergency medical treatment for my child.

Please choose either A (permission to act) or B (no permission to act)^*

If B, in the event of illness or injury requiring medical attention, I wish adults at BCC to take the following action:

A) I hereby give my consent to photograph and/or video my child for the purpose of showing pictures and/or video to the congregation of Bridgewater Community Church and/or social media. B) I do NOT give permission to have my child photographed and/or videoed at BCC.

Please choose A (permission for media use) or B (no permission for media use)^*

A) I give permission for my child to be transported to and from events by volunteer drivers authorized by Bridgewater Community Church. B) I do NOT give permission for my child to be transported to and from events by volunteer drivers authorized by Bridgewater Community Church.

Please choose A (permission to transport) or B (no permission to transport)

Signature of parent/guardian^*

By filling in this electronic signature, you agree that this signature is official.

Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu..rm_next_btn{display:none!important}.rm_noscript_btn{display:block!important}