Youth Group Registration

Where? First Miami Presbyterian Church located at 609 Brickell Avenue, Miami FL
When? Every Sunday, 6 pm - 7:30 pm

Parent or guardian, please fill out one form per student.

Student Information

Email, phone, and address should be the parent's contact information.

Your name *

Email address *

Address *

Phone number *

Other Information

Student's Birthday *

Student's School Name *

Student's School Grade *

Allergies & Special Attention *

Does the student have any allergies or other special considerations we need to be aware of? If yes, please explain in the text box below.

Yes

If yes, type answer:

Parent's First Name *

Parent's Last Name *

Parent/guardian, would you like to volunteer? *

If you select a Yes option, background check and Safe Gatherings approval is required.

Yes - on Sundays

Yes - Special Events Only

Emergency Contact Name *

Please provide another person other than yourself.

Emergency Contact Phone Number *

Please enter phone number using this format: (_ _ _) _ _ _ -_ _ _ _

Who may pick up your child from Youth Group *

Please include full names of all authorized people including yourself.

Walker Authorization *

I give my child permission to walk home alone.

I do not give my child permission to walk home alone.

Waiver & Release Form *

PHOTO/VIDEO DISCLOSURE
During First Miami events or activities, photographs or videos may be taken by designated First Miami Presbyterian Church staff or approved volunteers for use in our website, social media, newsletters, and other publicity materials. Any video or photographs used as expressly indicated will not include the names of individuals. The sole purpose of this initiative is to showcase our activities and the programs happening at First Miami.

PHYSICAL ACTIVITY WAIVER
You should always consult your physician or other healthcare providers before changing your diet or starting an exercise program. I understand that there is a risk of injury associated with participating in the workout classes at First Miami Presbyterian Church. I hereby assume full responsibility for any and all injuries, losses, and damages that I incur while attending, exercising, or participating in the workout classes at First Miami. I hereby waive all claims against First Miami Presbyterian Church, its instructors, or partners or individuals, or otherwise, for any and all injuries, claims, or damages that I might incur.

COVID-19 WAIVER
I acknowledge and understand the following:
1. Participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist;
2. I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of the organizing party or parties; and
3. I hereby knowingly assume the risk of injury, harm, and loss associated with any activity, including any injury, harm, and loss caused by negligence, fault, or conduct of any kind on the part of the organizing party.

MEDICAL ACKNOWLEDGMENT AND RELEASE
I acknowledge the health risks associated with any activity at First Miami, including but not limited to transient dizziness, lightheadedness, fainting, nausea, muscle cramping, musculoskeletal injury, joint pains, sprains and strains, heart attack, stroke, or sudden death. I agree that if I experience any of these or any other symptoms during any activity at First Miami, I will discontinue my participation immediately and seek appropriate medical attention.
I DO HEREBY RELEASE AND FOREVER DISCHARGE FIRST MIAMI FROM ANY CLAIM WHATSOEVER WHICH ARISES OR MAY HEREAFTER ARISE ON ACCOUNT OF ANY FIRST AID, TREATMENT, OR SERVICE RENDERED IN CONNECTION WITH MY PARTICIPATION IN ANY ACTIVITY AT FIRST MIAMI.
As a participant, volunteer, or attendee, you recognize that your participation, involvement, and/or attendance at any First Miami Presbyterian Church event or activity is voluntary and may result in personal injury (including death) and/or property damage. By attending, observing, or participating in any activity, you acknowledge and assume all risks and dangers associated with your participation and/or attendance at any activity, and you agree that: (a) the First Miami Presbyterian Church. (b) the property or site owner of any activity, and (c) all past, present and future affiliates, successors, assigns, employees, volunteers, vendors, partners, directors, and officers, of such entities, will not be responsible for any personal injury (including death), property damage or other loss suffered as a result of your participation in, attendance at, and/or observation of any activity, regardless of any such injuries or losses are caused by the negligence of any of the organizing party or parties. BY ATTENDING AND/OR PARTICIPATING IN ANY FIRST MIAMI ACTIVITY, YOU ARE DEEMED TO HAVE GIVEN A FULL RELEASE OF LIABILITY TO THE ORGANIZING PARTY OR PARTIES TO THE FULLEST EXTENT PERMITTED BY LAW

Please type your full name below to indicate your agreement:
Please type your name to sign this medical release: