RBC Revolution Youth

Ramoth Baptist Church Youth Ministry

Annual Registration Form

Please provide us with the following information for your child to be registered to participate in the Youth Ministry of Ramoth Baptist Church for the next 12 months. This includes, but is not limited to, any programs, events, and trips such as Sunday School, Youth Group, Hiking Trips, Youth Evangelism Conference, and Summer Camp. This registration form is designed to inform and protect the parent/legal guardian, participating child, the adult leaders, Youth Pastor, and Ramoth Baptist Church. If you have any questions or concerns, please contact Pastor Jonathan at 703-935-9485 or email students@rbcstafford.org.

Participant Name

Participant Birthdate

YYYY

Male

6th Grade

Name of School where child attends currently

If you are a guest of or have been invited by someone associated with Ramoth Baptist Church, please list their name here:

Parent/Legal Guardian’s Name

Parent/Legal Guardian’s Phone

Parent/Legal Guardian’s Email

May we contact you via text or email concerning important RBC youth ministry information?

For Parent/Legal Guardian

Clear choice

Yes (text and email)

Text only

Email only

Additional Parent/Legal Guardian's Name

Additional Parent/Legal Guardian’s Phone

Additional Parent/Legal Guardian’s Email

May we contact you via text or email concerning important RBC youth ministry information?

For Additional Parent/Legal Guardian

Clear choice

Yes (text and email)

Text only

Email only

Home Address

Participant Mobile Phone

Participant Email Address

May we contact your child via text or email concerning important RBC youth ministry information?

For participant (child)

Clear choice

Yes (text and email)

Text only

Email only

Yes

Please list any allergies, special needs, or other concerns and information of which we should be aware. If none enter N/A

Please select

What does your participant plan to attend?

If not attending leave unchecked.

Youth Evangelism Conference January 17-18, 2025

Centrifuge Camp June 23-27, 2025

Please download and read the Ramoth Baptist Youth Ministry Code of Conduct and Dismissal Policy.

As a participating child in Ramoth Baptist Church’s Youth Ministries, I affirm by typing my name in the box below that I have read and understood the Code of Conduct and Dismissal Policy, and I will abide by it.

Child type first and last name below.

As a parent/legal guardian of a participating child in Ramoth Baptist Church’s Youth Ministry, I affirm by signing the agreement below that I have read and understood the Code of Conduct and Dismissal Policy, and I expect my child to abide by it.

Parent type first and last name below.

Medical Emergency Permission

When on a trip off the church's campus, in the event of an emergency and failure to reach a parent/legal guardian, I hereby give my permission to a licensed physician or an adult leader from Ramoth Baptist Church to hospitalize my child as named above. In a life-threatening emergency, I also grant permission for a licensed physician to secure proper treatment for, and to order injections, anesthesia or surgery for my child as named above. I acknowledge that Ramoth Baptist Church and Youth Ministry does not provide any health insurance covering my child. I further acknowledge that it is my responsibility to obtain health insurance covering said child. I agree to accept the sole responsibility for the cost of medical care.

I acknowledge my permission is given for EMERGENCY MEDICAL CARE by signing the agreement below.

Clear choice

I understand

PARTICIPATION PERMISSION & RELEASE OF LIABILITY
As a parent/legal guardian, I grant the following child permission to participate in the Youth Ministry programs, events, and trips of Ramoth Baptist Church for the next 12 months. I realize that this may involve traveling to and from activities in the church bus or chaperone’s vehicle. By signing this form I do hereby relieve Ramoth Baptist Church and the adult leaders and Youth Pastor of any and all liability that may occur.

I acknowledge my permission is given for PARTICIPATION PERMISSION & RELEASE OF LIABILITY by signing the agreement below.

Clear choice

I understand

Signed Agreement of the Parent/Legal Guardian