2025-26 SURGE REGISTRATION

Your registration also signifies your approval of the use of pictures taken at events, to be used in our social media or publications. We do not identify or tag students by name in any of our materials, unless permission is given. It also signifies permission for CLC to contact you via email and SMS (text) communications.

STUDENT INFORMATION

Legal Name

Nickname

Birth date:

Student's Picture

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Member of CLC?

Yes No, but this is our church. Please email me more information about membership. No, member of another church No, not currently interested

Communication Approval*

Approve direct texts to students. Prefer all communication to parents/guardians.

*Communication Approval. Most communication will be sent to parents/guardians via email. Occasionally, small group leaders may text about upcoming events & activities. Please indicate if you approve direct texts to your student or if you'd prefer all communication to go to the parents/guardians.

Is this student baptized?

Yes No, I'd like more information.

Has this student celebrated first communion?

Yes No, please email me more information.

School:

Grade for 2025-26 School Year

Special information (allergies, medical, family, etc., see description below *)

* Please include NEED TO KNOW circumstances (Medical/Special Needs: Allergies, ADHD, Autistic, Behavioral Issues, etc.), special accommodations, or Family Dynamics (Divorce, split custody, etc.). This information will be for Ignite's files only.

HOUSEHOLD INFORMATION

Parent/Guardian #1 - First & Last Name

Parent/Guardian #1 - Cell Phone

Parent/Guardian #1 - Email

This address will receive a confirmation email

Parent/Guardian #1 - Address

Parent/Guardian #2 - First & Last Name

Parent/Guardian #2 - Cell Phone

Parent/Guardian #2 - Email

Parent/Guardian #2 - Address (if different from parent/guardian #1)

EMERGENCY CONTACT

Emergency contact - NOT parent/guardian. To be contacted in the event of an emergency and a parent/guardian cannot be reached.

Emergency Contact - First & Last Name

Relationship to Student

Emergency Contact - Phone

Emergency Contact - Alternate Phone

PARENT/GUARDIAN - ROLES & RESPONSIBILITIES

Like all youth programming at CLC, Ignite/Surge are parent/family driven ministries. Parents play the largest role in shaping their child's faith formation.

It is our expectation that all parents/guardians serve at Ignite/Surge. Please share with us in what area(s) you plan to serve in the 2025-26 programming year.

IMPORTANT INFORMATION - READ CAREFULLY

Consent to Treatment

Yes, I agree *

* I/We do consent to any x-ray, anesthetic, medical, surgical, dental diagnosis, or treatment that may be deemed necessary for my minor child. Further, I understand that all efforts will be made to contact me prior to treatment. In the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. I further understand that the doctors, dentists, and other providers attending to my child will take all reasonable safety precautions during their care. Further, as parent or legal guardian I am financially responsible for the health care decision for my minor child and agree that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child. Any policy of the church or organization sponsoring this event will be used as the secondary coverage.

Commitment

Yes, I agree *

* By taking part in Surge, students will form real and lasting relationships with each other, with caring and compassionate adults, and of course, with God.

By choosing to have my child in Ignite Confirmation/Surge at CLC, our family is making a commitment to the faith formation of our child by participating in worship and serving regularly.

As the parent/gaurdian I agree to play an active role in my child's faith formation.

I will partner with the CLC staff/volunteers in this life-changing/life-giving path of discipleship where we grow closer to God and to each other through worship, fellowship, service, discipleship and outreach.

2025-26 SURGE REGISTRATION

Description

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