GROVE CITY ALLIANCE CHURCH STUDENT MINISTRIES

All-Year Participation Form

September 1, 2013 August 31, 2014
I/We give consent for (print name of minor) ___________________________________________ to attend any Student Ministries event being sponsored by Grove City Alliance Church. In the event that he or she is injured while under the care of Grove City Alliance Church and its representatives and requires the attention of a doctor, I hereby consent to and will be responsible for any reasonable medical treatment as deemed necessary by a licensed physician. I/We further agree to hold Grove City Alliance Church and its representatives free and harmless of any claims, demands or suits for damages. I/We understand the nature of the event and do hereby release the Grove City Alliance Church and its representatives from any liability due to accident or injury incurred by my child. I/We agree to cover all costs if our student needs to be sent home for disciplinary reasons. I/We understand that my minor may be traveling in personal vehicles, 15 passenger vans, school buses or coach buses.

Parent/Guardian Signature ____________________________________________________ Name of Parent/Guardian (print) ________________________________________________ Students Name ______________________________________________________________ Address _____________________________________________________________________ City ________________________________________ State ______ Zip ________________ Telephone at Home ( Telephone at Work ( ) _________________________________________________ ) __________________________________________________

Cell phone __________________ Provider __________________ Texting? ___ Yes ____ No Email [required] ______________________________________________________________ Students Birthday ____________ Grade ____________ School ___________________ Special Medications or Allergy Medication _______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ *Note: Grove City Alliance Church will not be responsible for administering critical or special medications. Family Doctor/Name of Practice _________________________________________________ Doctors Phone ( ) _____________________________________________________

Insurance Company ___________________________________________________________ Group # _______________ Policy # ______________________________________________

In the event of an injury, a parent/guardian will be notified immediately.

Grove City Alliance Church 845 North Liberty Road, Grove City, PA 16127 724.458.8497 blazestudents.org

GROVE CITY ALLIANCE CHURCH STUDENT MINISTRIES

All-Year Covenant of Conduct Form

Sept 1, 2013 August 31, 2014
During any and all of the events within the 2013-2014 year, we will be doing our best to live together as a family in Christian community. ach !erson is very im!ortant. "ur life together will be based on love, res!ect, trust, su!!ort and time s!ent together. #n order to have safe and life-changing e$!eriences, clear e$!ectations are needed between all who are involved. %lthough we try to &ee! rules to a minimum, it is im!ortant that we lay out clear e$!ectations for your involvement in this community. 'lease read and sign this covenant of conduct. # understand that there is no alone-time between males and females. # understand that there are no drugs, alcohol or tobacco !roducts allowed at youth gatherings. # will not bring or use these items for any grou! activities. # will not bring with me or !urchase firearms, air rifles or !istols, (( guns, aero soft guns, re!licas of firearms or any &ind of wea!onry or firewor&s. # will show res!ect and obey all adults in charge. # will care for and res!ect the church !ro!erty or !ro!erty where we will be visiting and)or wor&ing. # understand that my !arents and # will be financially res!onsible for !ro!erty # damage through negligence. # will be res!onsible for my own belongings and res!ect the belongings of others. # &now that my !arents and leaders care about my well-being and # want to be safe, therefore, # agree to stay within the designated *rove City %lliance +tudent ,inistries set boundaries, stay in grou!s of three or more, res!ect gender s!ecific areas -restrooms., follow rules during tri!s and communicate with my grou!. # will remember not to be e$clusive in my relationshi!s. #f my boyfriend)girlfriend is !resent, # will ma&e every effort to interact with all the members of the grou!. # will abide by *rove City %lliance +tudent ,inistries !hysical affection guidelines. -(asics/ *uys are blue and girls are !in&0!ut them together and it ma&es !ur!le. 1o !ur!le. 2here will be no !hysical affection allowed. #t will be a distraction to you and others. Cou!les are 1"2 allowed to be alone anywhere.. # will refrain from gossi! and C",'3%#1#1*. # will abide by the cell !hone usage !olicy any time we gather together. Cell !hones can be a ma4or distraction during mission tri!s, retreats, cam!s and youth grou!. #f cell !hones are not needed, we will as& that you leave them turned off or at home. #f an urgent situation arises, an adult leader may give !ermission to use a cell !hone. # will res!ect and abide by all the *rove City %lliance Church +tudent ,inistries rules. # will abide by the *rove City %lliance +tudent ,inistries dress code. # will res!ect a leaders5 re6uest to change my clothing to more a!!ro!riate attire. # agree to follow all of the above e$!ectations because # desire to re!resent 7esus in a !ositive manner at all times. #n the unli&ely event that my behavior becomes out of control and it is necessary for the authorities to be contacted, # understand that arrangements will be made for my trans!ortation home at the e$!ense of my !arents. # understand that if # brea& this covenant, # may be sent home at the e$!ense of my !arents. 8888888888888888888888888888888888888888888888888888888888888888888888888 88888888888888888 'rint 1ame +ign Date

# understand as a !arent, that if my child brea&s this covenant, he)she may be sent home at my e$!ense. 8888888888888888888888888888888888888888888888888888888888888888888888888 888888888888888888 'arent)*uardian +ignature +ign Date