River of Life Christian Church (ROLCC) Youth Ministry Registration Form 2023-2024
Thank you for your interest in joining the ROLCC Youth ministry! Please register by leaving your contact information and selecting a life group. If you do not know which life group to join yet, please register and select "Not Decided Yet" from the Life Group drop-down so as to start receiving general Youth Ministry information. May God bless you!


Junior High Life Groups:
  BerryTino JH (6-8 grade of combined Berryessa & Cupertino JH)
  Fremont JH (6-8 grade)
  TogaAlto JH (6-8 grade of combined Saratoga & Palo Alto JH)

Hybrid Life Groups (combined JH and HS):
  San Mateo (6-12 grade)

High School Life Groups:
  Berryessa (9-12 grade)
  Cupertino (9-12 grade)
  Fremont (9-12 grade)
  Togill (9-12 grade of combined Saratoga & Morgan Hill HS)
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Youth Information
Life Group *
Youth First Name *
Youth Last Name *
Youth Email *
Youth Cell Phone
no hyphen such as 4081234567
School
2023-2024 School Grade *
Parent Information
Parent 1 - First Name *
Parent 1 - Last Name *
Parent 1 - Email *
Parent 1 - Cell Phone *
no hyphen such as 4081234567
Parent 2 - First Name
or legal guardian
Parent 2 - Last Name
or legal guardian
Parent 2 - Email
or legal guardian
Parent 2 - Cell Phone
no hyphen such as 4081234567
City
Zip Code
Parent's Specialty
if applicable
Parent Volunteer categories
if interested
LIABILITY RELEASE
Offsite Events: LIABILITY RELEASE FORM - Release of All Claims *
In consideration for being invited by River of Life Christian Church (ROLCC) to participate in the off site special events organized by ROLCC located off site from the premises of the facilities located at 1177 Laurelwood Road, Santa Clara, California occurring from Jul 1, 2023 and any date thereafter, we (I) being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age or older] hereby release, forever discharge and agree to hold harmless ROLCC, its employees, directors, officers, staff members, volunteers, agents, successors, and assigns (collectively “released parties”) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the youth participant that occur while said youth is participating is participating in an  off­site  special event. Please see  EVENTS RUBRIC shown below.  Furthermore, I/we being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age] hereby assume all risks of personal injury, sickness, death, damage and expense as a result of participation in any and all off site special events, meetings and gatherings related to youth ministries.  Additionally, I/we give authorization and permission to ROLCC or its representatives to furnish any necessary  transportation for my youth participant. This release covers transportation provided by ROLCC and their representatives who are properly licensed to drive in the State of California and who will be driving the youth to/from ROLCC and to/from any other off site event location for the sole purpose of attending the off site special event program and activities. Any deviation from the route to/from ROLCC and to/from off site special event program is  not covered under this waiver. And should it become necessary for the youth participant to return home due to medical reasons, disciplinary action, or behavior requiring special attention, we (I) hereby assume all associated transportation costs.  I/We give authorization and permission to ROLCC or its representatives to furnish any food and non-­alcoholic beverages to my youth participant. I/We will be responsible to make known my son’s/daughter’s food and beverage allergies. Reasonable measures will be taken to make sure food and beverage allergies are avoided for youth participants who may be susceptible to certain dietary allergens.  Further, authorization and permission is hereby given to said church to assist in furnishing any necessary lodging for my/our youth participant. Lodging safety is guaranteed to the extent reasonable by the off site hotel or conference center organization providing the accommodations. The undersigned further hereby agree to hold harmless and indemnify River of Life Christian Church (ROLCC), its employees, directors, officers, staff members, volunteers, agents, successors, and assigns for any injury, harm or death sustained by said church as the result of the negligent, willful or intentional acts of my/our youth participant, including any expenses incurred as a result of his or her acts.
Required
Onsite Events: LIABILITY RELEASE FORM - Release of All Claims *
In consideration for being invited by River of Life Christian Church (ROLCC) to participate in church activities organized by ROLCC on church premises, located at 1177 Laurelwood Road, Santa Clara, California, and for activities occurring from Jul 1st, 2023 and any date thereafter,we (I) being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age or older] hereby release, forever discharge and agree to hold harmless ROLCC, its employees, directors, officers, staff members, volunteers, agents, successors, and assigns (collectively “released parties”) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the youth participant that occur while said youth is participating in a church sponsored activity.  This release also covers the weekly organized youth group meetings which may take place, from time to time, at the primary residence of youth leader, ministry leader, or other ROLCC church members. We (I) being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age or older] hereby release, forever discharge and agree to hold ROLCC, its employees, directors, officers, staff members, volunteers, agents, successors, and assigns (collectively “released parties”) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child­ participant that occur while said child is participating at the primary residence of a youth leader, ministry leader, or other ROLCC church member.  Furthermore, I/we being twenty­one (21) years of age or older, do for ourselves (myself) [and for and on behalf of my youth participant, if my youth is not yet twenty­one (21) years of age] hereby assume all risks of personal injury, sickness, death, property damage and expense as a result of participation in any and all onsite events, weekly youth meetings, and gatherings related to youth ministries.  Additionally, I/we give authorization and permission to ROLCC or its representatives to furnish any necessary transportation for my youth participant. This release covers transportation provided by ROLCC and their representatives who are properly licensed to drive in the State of California and who will be driving the youth to/from ROLCC or any other weekly youth group meetings at the primary residence of youth leader, ministry leader, or church member, during youth program and youth activities. And should it become necessary for the youth participant to return home due to medical reasons, disciplinary action, or behaviour requiring special attention, we (I) hereby assume all associated transportation costs.  2 I/We give authorization and permission to ROLCC or its representatives to furnish any food and non­-alcoholic beverages to my youth participant. I/We will be responsible to make known my son’s/daughter’s food and beverage allergies. Reasonable measures will be taken to make sure food and beverage allergies are avoided for youth participants who may be susceptible to certain dietary allergens.  The undersigned further hereby agree to hold harmless and indemnify River of Life Christian Church (ROLCC), its employees, directors, officers, staff members, volunteers, agents, successors, and assigns for any injury, harm or death sustained by said church as the result of the negligent, willful or intentional acts of my/our youth participant, including any expenses incurred as a result of his or her acts.
Required
Youth Medical Information
Hospital Insurance *
Insurance Company
Required if you have hospital insurance.
Insurance Policy Number
Required if you have hospital insurance.
Physician's Name
Required if you have hospital insurance.
Physician's Phone
Required if you have hospital insurance.
List all known medical needs and allergies of the youth
Please indicate if your youth has any special need (i.e., social or learning disabilities.) This information will be confidential and will help the Youth Ministry better support your student.
Submit
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