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Home
About
Who We Are
What We Believe
Our Vision
Our Shepherds
Our Ministers
Contact Us
Worship Times
Ministries
Children
Youth
College
Iglesia de Cristo
Benevolence
Missions
Latch Key
Life Groups
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Resources
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Latest Sermons
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New Member
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Family Name
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Last
Date
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Address
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Street Address
Address Line 2
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Head of House
Marital Status
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Anniverssary Date
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Birthdate
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Children
How many children do you have?
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Child 1
Name
*
First
School
Birthdate
*
MM slash DD slash YYYY
Baptism Date
*
MM slash DD slash YYYY
Grade
Phone
Email
Child 2
Name
*
First
School
Birthdate
*
MM slash DD slash YYYY
Baptism Date
*
MM slash DD slash YYYY
Grade
Phone
Email
Child 3
Name
*
First
School
Birthdate
*
MM slash DD slash YYYY
Baptism Date
*
MM slash DD slash YYYY
Grade
Phone
Email
Child 4
Name
*
First
School
Birthdate
*
MM slash DD slash YYYY
Baptism Date
*
MM slash DD slash YYYY
Grade
Phone
Email
Other Adult
Name
First
Relationship
Birthdate
MM slash DD slash YYYY
Baptism Date
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Phone
Email
Update Member
Name
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First
Last
Email
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Phone
Updated Information
Please let us know any other information you would like to update.
Camp Scholarship Application
Scholarship application is due by March 28.
1
2
Name of Person Filling Out This Application
*
First
Last
Email
*
Phone
Number of Children Applying for Scholarship
*
Child Name
*
Child 2 Name
*
Child 3 Name
*
Child 4 Name
*
Which session are you hoping to register your camper(s) for?
*
1st Session | May 30 – June 4
2nd Session | June 6 – June 18
3rd Session | June 20 – June 25
4th Session | June 27 – July 9
5th Session | July 11 – July 23
6th Session | July 25 – July 30
Please share why you feel it is important for your child or children to attend CDR this summer?
Please share a brief explanation of your need for financial assistance. This does not need to be lengthy, but please summarize your situation.
How much can you reasonably afford to pay towards your campers’ fee?
Parent Consent Agreement
1
General Information
2
Medical Information
3
Consent
Name of Child
*
Date of Birth
*
MM slash DD slash YYYY
Parent/Guradian Name(s)
*
Relationship to Child
*
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
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Delaware
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Georgia
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Iowa
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Ohio
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Puerto Rico
Rhode Island
South Carolina
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Tennessee
Texas
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Vermont
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Washington
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Wisconsin
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Armed Forces Americas
Armed Forces Europe
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State
ZIP Code
Parent/Guardian Phone
*
Secondary Phone
Additional Emergency Contact
Additional Emergency Phone
Family Doctor Name
Family Doctor Phone Number
Health Insurance Provider
Policy Number
Child's Medical Conditions/Surgeries
Current Medications and Conditions They Treat
Does your child carry an inhaler or epi-pen?
*
Yes
No
Does the youth minister/sponsors have permission to give your child the following medications if needed:
Tylenol
*
Yes
No
Ibuprofen
*
Yes
No
Pepto Bismol
*
Yes
No
Benadryl
*
Yes
No
Coritsone Ointment
*
Yes
No
Antibiotic Treatment
*
Yes
No
Today's Date
*
MM slash DD slash YYYY
Counseling Policy
*
I consent to the Counseling Policy
Because your child is a minor, Lamar Avenue Church of Christ requires a consent for your child to seek advice and counsel from adults (youth minister, sponsors, interns, preacher, elders, etc). As the parent/guardian, it is your responsibility for the physical, emotional, and spiritual well being of your child; however, we need your consent to talk with your child when they approach us with emotional or spiritual problems. Sometimes their problems are of a sensitive nature which requires your knowledge that these conversations may occur now or in the future. This consent is for the benefit of your child and to protect the church and those working with your children.
If my child (named above) should seek the advice and/or counsel of a youth minister, sponsor, intern, preacher, elder, etc, for emotional and spiritual concerns, I consent to this interaction and understand that all conversations between the youth leader and my child exist for the benefit of my child, and that the youth leader will keep conversations confidential unless the he/she determines my child is in imminent danger of harming him/herself or others; however, youth leaders will always encourage parent/child interaction on these issue.
Medical Release
*
I consent to the Medical Release
I consent to my child’s participation in Lamar Avenue Church of Christ children’s/youth events. If my child should require medical treatment because of injury or illness during such sponsored activities/trips, I/we consent to medical treatment in an emergency by the event sponsor/youth minister or if I/we are unable to consent to such treatment.
I/We agree to be financially responsible for any medical bills incurred as a result of emergency or other medical treatment. Any special medical conditions/medications will be so noted below for the benefit of the youth leader(s) who will notify emergency medical personnel at the appropriate time.
I/ We acknowledge that I/We have read the foregoing medical consent and understand it and sign it voluntarily. I/We are the parent (s) or legal guardian of the child specified in this form and am at least eighteen years of age and fully competent and fully intend to be bound by the terms of this agreement.
