Parkside Students Registration

We're excited to have your student(s) join us at Parkside Students! In order to better serve you, please provide us with some information about your family. We look forward to getting to know you and your student(s) better!

Parent's Name

This address will receive a confirmation email

Phone

Address

Emergency Contact

Please include name of contact, phone number, relationship to students and any other pertinent information.

Medical Release

I hereby release and hold harmless Parkside Church from responsibility and liability for any illness or injury that my child may sustain during church activities, provided they have exercised reasonable caution and supervision toward the safety of my child. In the event of an emergency, where immediate care is needed and the staff has exhausted all manners of contacting me, I hereby authorize an adult leader of this activity, as agent for me, to arrange medical care for my child. (If you have questions/concerns about this Medical Release, please email krista@parksidemn.org).

Media Release

I authorize Parkside Church to utilize photos/videos taken of my student(s) at events for promotional purposes (Parkside Instagram/Facebook/Website). At no time will Parkside Church photos/videos be used by any unrelated organization. (If you have questions/concerns about this Media Release, please email krista@parksidemn.org).

Please Complete for Each Family Member

Secondary Adult Name

Phone

First Student's Name

Birthdate (month/day/year)

Grade (6th-12th)

Gender

Male Female

Allergies?

Student's Phone

Student's Email

Second Student's Name

Birthdate (month/day/year)

Grade (6th-12th)

Gender Male Female

Allergies?

Student's Phone

Student's Email

Third Student's Name

Birthdate (month/day/year)

Grade (6th-12th)

Gender Male Female

Allergies?

Student's Phone

Student's Email

Fourth Student's Name

Birthdate (month/day/year)

Grade (6th-12th)

Gender Male Female

Allergies?

Student's Phone

Student's Email

Parkside Students Registration

Description

Please Fix the Following