Student Ministry Participation Form

This form is required for all students participating in Northwest Bible Church’s Student Ministry and applies to the 2025/2026 school year.

Your name *

Email address *

Address *

Phone number *

Marital status *

Student Information

Please add your student by selecting "Add child" below.

Household members

Check if this student has a mobile phone

Check if this student has an E-Mail address

Student Medical Information

Family Doctor/Practice *

Doctor’s Phone *

Insurance Company *

Insurance Phone *

Group Number *

Policy Number *

Does this student have any allergies or take any medications on a regular basis? *

Emergency Contact Other Than Parent

Emergency Contact Name *

Emergency Contact Phone *

Please use format (614) 876-7882

Consent

I/We give consent for (the student named above) to attend any Student Ministries events being sponsored by Northwest Bible Church. I/We also agree to forgo any money paid for a given event as refunds are only given in case of emergency cancellation (i.e. death in the family, illness). I/We understand this release form is valid from July 2025 to July 2026 in the Northwest Bible Church’s Student Ministry. I/We have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event and I/we hereby release Northwest Bible Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he or she is injured while under the care of Northwest Bible Church and its representatives and requires the attention of a doctor, I hereby consent to and will be responsible for any reasonable medical treatment as deemed necessary by a licensed physician. I/We further agree to hold the licensed physician, the medical facility, Northwest Bible Church and its representatives free and harmless of any claims, demands or suits for damages arising from the authorization and provision of such medical treatment. I/We understand the nature of the event and do hereby release the Northwest Bible Church and its representatives from any liability due to accident or injury incurred by my child. I/We agree to cover all costs if our student needs to be sent home if they become ill or for disciplinary reasons. I/We understand that my child may appear in photographs or videos that are used by Northwest Bible Church for promotional purposes including but not limited to brochures, promotional videos, and websites. I waive any rights to royalties or other compensation arising from or related to the use of such images and recordings.

Full Name of Parent Giving Consent *

Date of Birth of Parent Giving Consent *

By clicking you agree to and sign for the above. *