Ignite Youth Registration & Annual Participation Agreement

Ignite Youth
Grades 6th–12th | Wednesdays 6:00–8:00 PM |
Location: The Well Church — 3661 Poinsettia Ave SE, Grand Rapids, MI 49508
Youth Leaders: Max and Thea Johnson

Ignite Youth is a community of students in grades 6–12 who are hungry to grow in their relationship with Jesus and build strong community. We meet every Wednesday from 6:00 to 8:00 PM for a night full of worship, the Word, games, testimonies, and real conversation.

Parents: After signing up, you'll be added to our Ignite Youth Parents Slack channel for all updates, communication, and event info related to Ignite Youth. Watch for an email from Slack inviting you to set up your account.

For any questions or concerns, please email thea.johnson@thewellgr.com

STUDENT INFORMATION

First Name *

Last Name *

Age *

Birthdate *

School Grade *

Gender *

Home Address *

Many high-school aged youth manage their own schedules, and may benefit from being added to the parent communication Slack channel. Would your high-school age youth like to be added?

Yes, add my youth to Slack

Youth Phone Number for Slack *

Youth Email Address for Slack *

PARENT/GUARDIAN INFORMATION

Parent/Guardian Full Name *

Parent Phone Number *

Parent/Guardian Email *

Additional Parent/Guardian Name

Additional Parent/Guardian Phone Number

Additional Parent/Guardian Email

Add additional parent/guardian contact to Slack channel?

Yes, please add additional contact

No additional contact needed

Are there any custody arrangements or restrictions that we should be aware of?

Current church family is attending *

EMERGENCY CONTACT

Emergency Contact Full Name *

Emergency Contact Phone Number *

Relationship to Student *

MEDICAL INFORMATION

Allergies *

Medical Conditions *

Medications *

Is there any additional information we should know to safely and appropriately host your youth at Ignite?

Primary Care Physician *

Medical Insurance Company *

I understand this information will be shared only as reasonably necessary for my student's safety and care.

PICKUP & RELEASE

How will your student normally leave Ignite Youth? *

Parent/Guardian pickup

Approved adult pickup or carpool

High-school student will leave independently

Other

Please Describe *

I understand that I am responsible for promptly picking up my student when requested because of illness, injury, unsafe behavior, or another concern. The church may require identification before releasing a student when appropriate.

TRANSPORTATION AUTHORIZATION

I authorize The Well Church and its approved staff or volunteers to transport my student for church-sponsored activities using church, personal, rental, charter, or other appropriate transportation.

I understand that transportation may be provided by screened volunteer drivers who carry legally required automobile insurance. My student must wear a seat belt and follow all transportation safety instructions at all times.

PERMISSION TO PARTICIPATE & ASSUMPTION OF RISK

I give permission for my student to participate in Ignite Youth and other The Well Church/The Well International youth activities during this agreement's term, including weekly gatherings, camps, retreats, trips, service projects, sports, recreation, water activities, and other church-sponsored activities on or off church property.

I understand that participation involves inherent risks, including illness, communicable diseases, injury, accidents, transportation accidents, weather, water activities, food reactions, equipment failure, property damage, and other unforeseen hazards. I voluntarily assume these risks.

LIABILITY RELEASE & MEDICAL AUTHORIZATION

To the fullest extent permitted by Michigan law, I release and hold harmless The Well Church, The Well International, and their pastors, directors, officers, staff, leaders, volunteers, drivers, and representatives from claims arising from my student's participation or transportation, except where such release is prohibited by law.

If I cannot be reached in an emergency, I authorize church leaders to obtain emergency medical care, contact emergency services, arrange transportation, and consent to necessary treatment.

I understand that The Well Church does not provide health or accident insurance for participants and that I am responsible for medical and related expenses.

STUDENT CONDUCT

I understand that my student is expected to follow leader instructions, respect others and property, and behave safely and appropriately.

The Well Church may remove a student from an activity for unsafe, disruptive, or inappropriate behavior. I agree to promptly arrange pickup and accept responsibility for reasonable costs resulting from my student's intentional misconduct or rule violations.

MEDIA CONSENT

I give The Well Church/The Well International permission to photograph or record my student's image and/or voice for church-related websites, social media, livestreams, publications, and promotional materials.

I DO NOT consent to the use of my student's photo, video, or voice.

Media consent remains in effect for this agreement's term unless revoked in writing.

PARENT/GUARDIAN ACKNOWLEDGMENT

By signing below, I confirm that I am the student's parent or legal guardian, that the information provided is accurate, and that I have read and agree to this entire agreement.

I understand that this agreement is governed by Michigan law. If any provision is found unenforceable, the remaining provisions will remain in effect.

I understand that this form is effective for one year from date of signing.

Effective Date: *

Expiration Date: *

Parent/Guardian Digital Signature *

Date *