This registration is for Waverly Campus only

Student Reg Entry

Waverly Student Registration

Welcome parents! Please fill out this form to register your student for CHAOS or BIGhouse for the 2022/2023 school year.

Student's Information

First Name

Last Name

Current Mailing Address

NOTE: If student DOES NOT have a unique email address and/or mobile number, please leave this blank.

Mobile Number

Email Address

Gender

Birthday

/ /

Grade

School

Home Church (if any)

Which program will they attend?

CHAOS (grades 6-8) BIGhouse (grades 9-12)

If student has allergies (including food) or chronic medical conditions, please list below.

Primary Parent/Guardian Information

Please use unique email addresses and phone numbers.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Mobile Number

Parent/Guardian Email Address

Are you interested in volunteering on Wednesday nights? (Snack team, check-in, co-small group leader, etc)

Secondary Parent/Guardian Information

Please use unique email addresses and phone numbers. If not applicable, leave blank and fill out Additional Emergency Contact Information.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Mobile Number

Parent/Guardian Email Address

Are you interested in volunteering on Wednesday nights? (Snack team, check-in, co-small group leader, etc)

Additional Emergency Contact

If you DID NOT fill out information for 2 parents/guardians, please provide an additional emergency contact. Please use unique email addresses and phone numbers. We will ONLY contact this person in the case of emergency where parents/guardians cannot be reached.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Mobile Number

Emergency Contact Email Address

Student Permission Forms

I give my student permission to go off campus with a college-age or adult leader when notified in advance.

I give my student off campus permission

Yes No

I hereby grant Orchard Hill Church permission to use my student's likeness and name in photographs, video recordings or electronic images in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the organization and will not be returned. I hereby irrevocably authorize the organization to edit, alter, copy exhibit, publish or distribute these images for purposes of publicizing the organization's programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image. I hereby hold harmless and release and forever discharge the organization from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I hereby certify that I am the parent or guardian of the student on this form, and do hereby give my consent without reservation to the foregoing release on behalf of this person.

I give photographic release permission