Registration / Release Form

Child's Name(required)
Gender
Parents Names(required)
Address(required)
Apt #
City(required)
Postal Code(required)
E-Mail Address(valid email required)
Do You Have...?
Age(required)
School(required)
Grade(required)
The Best Way To Contact Me is(required)
Emergency Contact(required)
Home Phone #
Cell Phone #
Health Card #(required)
Family Dr(required)
Please Note: Videos and Photos Are Taken On Various JV Nights and Special Events. These Pictures Will Be Used For Embassy Student Ministries (Jr Varsity) Photo ID Cards, The Website (jrvarsity.org) and In-House Material.
Allow Child Photo To Be Taken and Used(required)

By hitting submit I give permission for my dependent named above to participate in the activities of the Jr High department of The Embassy Church. In case of medical emergency I understand that an attempt to contact myself will be done immediately. In the event that I am unable to be contacted or immediate attention is required I grant permission for the Jr High department staff/volunteers to act in the best intrest of my child. I will not hold The Embassy of the Kingdom of God (The Embassy Church), it’s Pastors, representatives or Board of Deacons from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of The Embassy of The Kingdom of God

The Embassy Church collects and retains the personal information for the purposes of enrolling your child in our programs, and to inform you of program updates and upcoming opportunities. This info will be maintained permanently as it is a requirement of our insurance company and legal counsel