CLIFF Parent & Student Information Form 2024

It is important that we receive ONE form submission per child so that we can obtain all important information for that child including any allergies, medications, medical conditions, or other information specific to that child.

After submitting the form, a link will be provided for your convenience to return to the form to register an additional child or children.

Thank you in advance.
Student Information
The below fields are for you to enter the student's information. 
There will be an area later in this form for parent/guardian information.
Please submit one form for each child.
 
 
 
 
Please select one option.
Please select one option.
Please select one option.
 
Health and Medical Information
 
 
 
 
Allergies: Please include food, medications, insects, other (put n/a if not applicable).
Please select all that apply.
 
 
 
 
 
 
 
 
Parent/Guardian Information
Please be as thorough as possible so that we may be able to contact you and keep you updated with changes to the schedule, weather cancellations, etc.  
 
*Please provide a Mobile/Cell # if you have one.  Information regarding announcements or cancellations may be sent via text.
 
 
Emergency Contact Information (if parent/guardian is unable to be reached)
 
Please select one option.
 
Permissions
By checking this box, I give permission for my child's photos/videos to be used in print/online at the discretion of Main Street Baptist Church.
Please select all that apply.
My permission is granted for Main Street Staff and Parents-in-charge to obtain necessary medical attention in case of sickness or injury to my child. I, the undersigned, do hereby verify that the above information is correct and I do hereby release and forever discharge all Main Street Staff, employees, and parents from any and all claims, demands, actions, or cause of action, past, present, or future arising out of any damage or injury while participating in youth events. I assume full financial responsibility for and agree to pay all expenses relating to medical treatment. 

I further agree that if my son or daughter creates a disciplinary problem necessitating early return from an event, I will be responsible for all related costs.
Electronic Signature
*By entering my name in the box below and pressing submit, I am electronically signing my name on this form
 
 
 
 

Description

It is important that we receive ONE form submission per child so that we can obtain all important information for that child including any allergies, medications, medical conditions, or other information specific to that child.

After submitting the form, a link will be provided for your convenience to return to the form to register an additional child or children.

Thank you in advance.