Regular Attender Form

At the end of this form, you will be asked for permission to have the following information published in our online church directory. Only regular attenders and members from within the church have access to this information.

Household Information

Head of Household:

Birth-date / numbers only / day-mo-yr (12-06-1984): (Will not be published.)

Spouse:

Birth-date / numbers only / day-mo-yr: (Will not be published.)

Address

This address will receive a confirmation email

Phone: Home

Phone: Cell(s)

Anniversary:

Children & Youth Living at Home

Hillcrest church will never publish any information other than your child's name. Four special concerns are listed we want to be aware of. For those that apply, space is provided at the end for greater detail.

Child 1

Name

Birthdate

Gender

Grade

School Name

Check if Allergies Special Needs Mobility Issues Medical Concerns

Child 2

Name:

Birthdate

Gender

Grade

School Name

Check if Allergies Special Needs Mobility Issues Medical Concerns

Child 3

Name:

Birthdate

Gender

Grade

School Name

Check if Allergies Special Needs Mobility Issues Medical Concerns

Child 4

Name:

Birthdate

Gender

Grade

School Name

Check if Allergies Special Needs Mobility Issues Medical Concerns

More than 4 kids? Give us their information here. Include full name, birthdate, gender, grade and school name. Also, please let us know if they have allergies, special needs, mobility issues, or medical concerns.

Children live with:

Emergency Contact:

Phone Number:

Other Adults Authorized to Pick Up Children:

How Can we Serve You?

Check all that apply. I would like to meet with a pastor. I would like to receive the emailed prayer requests. I would like to join a LifeGroup. I would like a church mailbox. I would ilke an offering envelope number. I would like to be baptized, or to have one of my chidlren dedicated to God. I would like access to RightNow Media.

Image Release

I consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of any of my family members while participating in Hillcrest programs to be used, distributed or shown, for promotional purposes, as Hillcrest Apostolic Church sees fit.

Check one.

I consent. I do not consent.

Our Privacy Commitment to You: Respecting your privacy is important to Hillcrest. According to "The Freedom of Information and Protection of Privacy Act", we will only publish your family information according to your specifications & permissions.

Please register me for the Online Church Directory. (You will receive an email with login instructions.)

Yes No

I give permission to publish my family information in the Hillcrest Online Church Directory.

Yes No Yes, with exceptions.

I would not like the following published in the online church directory:

In place of a signature, please check yes to show your agreeance and permission to use the above information for Hillcrest purposes.

Yes No

Today's date:

Waiver/Release Form for Parents with Children and Youth

Purposes and Extent:
Hillcrest Apostolic Church is collecting and retaining this personal information for the purpose of enrolling your child in our Sunday morning programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with your and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Hillcrest Apostolic Church to limit information collected or viewed, please contact us.

Medical Release:
I/We, the parents or guardians named above, authorize the ministry staff of Hillcrest Apostolic Church to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant/s named above. I understand that the ministry staff will make every effort to locate and notify me if my child is injured or becomes ill during a Sunday morning program.

I/We, named above, undertake and agree to indemnify and hold blameless the ministry staff, Hillcrest Apostolic Church, its pastors and Board of Elders from and against any loss, damage or injury suffered by the participant/s as a result of being part of the activities of Hillcrest Apostolic Church, as well as of any medical treatment authorized by the supervising individuals representing the church. I further acknowledge and understand that my child(ren) will be responsible for his/her failure to abide by the rules and regulations of the Sunday morning programs. This consent and authorization is effective only when participating in or traveling to events of the Hillcrest Apostolic Church.

I consent. I do not consent.

Today's date:

Please use this space to provide greater detail regarding allergies, special needs, mobility issues or medical concerns, etc.:

Any questions or comments:

Regular Attender Form

Description

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