2024-2025 Youth Group Online Registration

STUDENT NAME:*

First NameLast Name

DATE OF BIRTH:*

MonthDayYear

GRADE*

Grade for 2024-2025 school year

SCHOOL*

Name of school you are attending (or "homeschool")

STUDENT'S EMAIL:*

JR. HIGH or SR. HIGH?*

Jr. High (Ages 11-14 / Middle School)Sr. High (Ages 15-18 / High School)

PARENT/GUARDIAN NAME:*

First NameLast Name

ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PHONE NUMBER:*

PARENT/GUARDIAN EMAIL:*

MODEL RELEASE OF A MINOR (SELECT ONE)*

YES - Calvary Chapel Quakertown has the absolute right and permission to take, use, reuse, publish, and republish photographic/video portraits (except for pornographic, defamatory, or sinful use) or pictures of the minor or in which the minor may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations from time to time, in conjunction with the minor's own or a fictitious name, or reproductions of such photographs in color or otherwise, made through any medium at Calvary Chapel Quakertown’s facilities or elsewhere, and in any and all media now or hereafter known, including the internet, for art, advertising, trade, or any other purpose whatsoever.NO - Permission is not granted at this time.

To review the full model release form, click HERE.

By registering, you agree to be bound by the terms of Calvary Chapel of Quakertown’s Resolution on Participation in Church Activities, which can be found at this link:

https://ccquakertown.org/church-activities-resolution/

If you do not have Internet access, you may obtain a copy of the Resolution on Participation in Church Activities from the church office.

2024-2025 YOUTH GROUP