Student Information Form 2024-2025

Please fill out this form and click submit.
Please select all that apply.
 
 
Please select one option.
Please select one option.
 
 
 
 
Parent/Legal Guardian Information

 
 
 
 
 
 
Helpful Information

 
 
 
 
 
 
 
 
 
 
 
 
Insurance Information

 
 
 
 
 
 
 
Waiver

As the parent/legal guardian of this child, I give permission for him/her to participate in any activities pertaining to the Children's/Youth ministries at Harlem Reformed Church. I also release Harlem Reformed Church, their staff and volunteers from any liabilities that could result from unintentional accidents and/or self inflicted harm. I also give permission for him/her to receive medical treatment deemed necessary by appropriately trained medical personnel. I also give permission for the use of photographs in which they are included for church publicity.
Please select all that apply.
 
 

Description

Please fill out this form and click submit.