Haven Heights ABC Registration Form 2025-2026

The information on this form is for the sole use of children and youth leaders of Haven Heights Baptist Church and is not available to other individuals or groups. This information will not be disclosed without your consent.

Student Information

Name

Date of Birth

Gender

Address

Grade (the grade the child will enter in the fall of 2025)

School

Does this child need transportation by the Haven Heights van?

Please note any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, etc…) of which Haven Heights staff and volunteers should be aware.

Please list any special dietary needs of which Haven Heights staff and volunteers should be aware.

Parent/Guardian Information

Contact 1

Phone

This address will receive a confirmation email

Contact 2

Phone

This address will receive a confirmation email

I, the parent or guardian, give permission for my student (as listed above) permission to attend and participate at Haven Heights Baptist Church.

Yes, I give permission for my child to attend No, I do not give permission for my child to attend

I, the parent or guardian, acknowledge and accept that my student (as listed above) is participating at their own risk.

Yes, I understand No, I do not understand

I, the parent or guardian, realize and accept that if my student’s (as listed above) behavior or health adversely affect the safety and well being of the group, Haven Heights reserves the right to deny participation.

Yes, I understand No, I do not understand

Photo Release for Minors

Haven Heights Baptist Church has my permission to use my or my child’s photograph publicly to promote the church and/or ABC. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of use.

Photo Release

I give my permission for my child's picture to be used I do not give my permission for my child's picture to be used

Haven Heights ABC Registration Form 2025-2026

Description

Please Fix the Following