Student Ministry (6th-12th Grade) 2017-18 Registration & Health Information Form

This form is effective from
Sept. 1, 2017 - Aug. 31, 2018.
Please fill it out and click submit.
Student Information

Parent Information

Students Emergency/Medical Information

WCC Waiver and Release from Liability

- I acknowledge that my child’s participation in Woodbury Community Church (WCC) Student Ministries is voluntary and may require involvement in activities that require traveling or physical exertion. Such activities may include, but are not limited to: outings, athletic games, local excursions, and meetings. I acknowledge that my child’s participation in any WCC student activities presents risks that my child may suffer property damage, bodily injury, or death. Therefore, in consideration of my child’s being allowed to participate in the WCC student program activities, I agree to the following:

- Woodbury Community Church is not responsible for the loss or theft of person belongings.

- Misconduct may result in transportation home from any activity at parents’ expense. A student dismissed for a disciplinary reason will not receive a refund of the activity fee.

- I understand and authorize that my child’s image may be photographed or filmed and used in Woodbury Community Church video presentations, printed publications and website.

- I hereby take the following action for my child, myself, my executors, administrators, heir, next of kin, successors and assigns:
A) I waive, release and discharge from any and all claims or liabilities for death or personal injury damages of any kind, which arise out of or relate to my child’s participation in WCC’s Student activities, the following person, or entities: Woodbury Community Church, it’s Senior Pastor, Elders, employees, volunteers, representatives, subcontractors and agents of any of the above: B) I agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released or discharged herein except in the case of gross negligence on the part of WCC, WCC staff or volunteers and: C) I indemnify and hold harmless the person or entities mentioned above from any claims made or liabilities assessed against them as a result of my child’s actions. I hereby assume the risks of my child participating in all WCC Student Ministries.

- As the parent and natural guardian or legal guardian of this student, I hereby execute this document for and on behalf of the minor named herein. I agree to indemnify and hold harmless the person or entities mentioned above for any claims or liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the minor in the execution of the Waiver and Release.

- I hereby authorize any licensed physician, emergency medical technician, hospital or other medical or health care facility to treat the minor named herein for the purpose of attempting to treat or relieve any injury received by said minor. I authorize any such Medical Provider to perform all procedures deemed medically advisable in attempting to treat or relieve any such injuries. I consent to the administration of anesthesia as deemed advisable. I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and I assume any such risk for and on behalf of myself and said minor. I understand that attempts will be made to contact me in the most expeditious way possible. Permission is also granted to WCC representative to provide the needed emergency treatment to the student prior to his admission to a medical facility.

- I give my permission to the WCC staff to administer Tylenol/Acetaminophen, Ibuprofen, Benadryl/Diphenhydramine or over the counter antacids as needed.

- For your information, these are our rules of conduct expected from each student:
> Respect one another, staff & adult leaders
> No fighting, weapons, fireworks, explosives
> Participation with the group is expected
> No boys in girl’s sleeping quarters
> No girls in boy’s sleeping quarters
> Acceptable swim attire (girls:1-piece or tankini, guys: no speedos)
> No students permitted to drive for events
> No offensive or immodest clothing
> Respect and comply with event schedules
> Respect property
> No Pranks
> No alcohol, drugs, tobacco
> No lighters permitted

> Failure to comply with these expectations could result in your child being sent home at your expense.

- My child has permission to attend all church sponsored Student Ministry activities as listed in WCC calendars, website and/or announcements, including but not limited to the following: cook-outs, boating, water-skiing, swimming, basketball, roller-skating/blading, ice-skating, games in the park, soccer, paintball, broomball, volleyball, softball, baseball, camping, downhill skiing, snow-boarding, hiking, biking, concerts, Bible studies, golfing, miniature golf, hayrides. Note: If it is your desire to limit your child(ren)’s participation in any event, please submit your wishes in writing to Woodbury Community Church prior to that event.

By submitting this form, I verify that all Health information is accurate and the Waiver & Release information has been read and approved.


This form is effective from
Sept. 1, 2017 - Aug. 31, 2018.
Please fill it out and click submit.