LifePointe Christian Church Youth Ministries 2024 Student Activity Packet

Every school year, parents and students are required to submit a new SAP (Student Activity Packet) before participating in any Student Ministry event or activity. This once-a-year “red tape” enables us to provide safety and care for your child and ensure that we have current contact information for you.

This packets contains the following:
Behavior Guidelines Form
Permission/Emergency Treatment Medical Form

Every school year, parents and students are required to submit a new SAP (Student Activity Packet) before participating in any Student Ministry event or activity.This once-a-year “red tape” enables us to provide safety and care for your child and ensure that we have current contact information for you.

This packets contains the following:

Behavior Guidelines Form

Permission/Emergency Treatment Medical Form

QUESTIONS:

When must I turn these in?

We advise LCCYM families to turn this in at the beginning of the calendar year to cover EVERY activity for that year. A completed SAP is required before participation in any activity.

What must I turn in?

1. A completed SAP packet (all forms) signed by both student and parent

2. A current copy of your health insurance card

3. If medication is needed by your child (extra forms required at each event)

How do I register for events?

All registration is done online at https://lifepointechristian.net/students

10 GUIDELINES

LCCYM Events and activities are intended to provide opportunities for communal spiritual growth, and relationship building with other students and adult leaders. Please view the guidelines listed here as you do the doors to your house. Their purpose is to keep certain things out and provide a more comfortable environment for those inside.

NOTE: Failure to follow the guidelines, or others that are given at the event, may result in the immediate dismissal of the student.

1)Do not bring alcohol, tobacco of any kind, illegal drugs, guns, fireworks, ninja stars, grenade launchers or anything else that is potentially dangerous or depressing.

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

2) For some activities you may be required to leave your iPod, MP3 player, video games, or any other electronic devices (other than cameras) at home. Cell phone use may be restricted or prohibited during all or part of an event in order to minimize distractions and maximize engagement in the event. Some events take place in areas where reception is nonexistent or poor. Check the event agenda that you receive prior to departure. Sometimes technology use will be encouraged.

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

3) Dress Appropriately. We encourage students to consider modesty in all things, so that focus is on growth and learning, not each other. If it is against your school rules, don’t bring it. At the discretion of the LifePointe staff or sponsors, a student may be asked to cover up or change his/her clothing if it is deemed inappropriate.

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Please select all that apply.

Student Has Read And Understands Parent Has Read And Understands

4) Keep your conversations clean and encouraging. Avoid verbal arguments, yelling, offensive language, gossip or hurtful comments.

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

5) Do not engage in any action with someone else that is (or would appear to be) inappropriate behavior. This includes crude humor and inappropriate touch of any kind. This also includes lying on each other in the vans, “disappearing together”, kissing, etc. (Dating and displays of attraction and affection should take place on your own personal time, not during a ministry event.)

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

6) Pleeeease, no WHIIIIIINING!

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

7) Stay in your assigned sleeping area after the appointed “lights out” and “wake up”.

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

8) Show respect to all adult leaders. They are here to help you have the best and safest event possible.

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

9) Follow the assigned schedule. Be where you need to be, when you need to be there. This includes food stops, program schedule, etc.

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

10) Stay flexible, positive and honest. Our leaders love these qualities!

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Please select all that apply.

Student Has Read and Understands Parent Has Read And Understands

Student - Section 1
I, __Student Name, date__ as the student, agree to abide by the guidelines set by LifePointe Christian Church Youth Ministries (LCCYM). I understand that if I choose to ignore or not follow these guidelines I will be susceptible to the consequences imposed by the adult staff or student minister, which may result in my immediate dismissal from the event or activity.

Student's Typed Signature

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Put Date Here

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Parent or Legal Guardian - Section 2
I, ___Parent Name, Date__, have read and understand the guidelines listed. I understand that noncompliant students will be asked to leave the event or activity regardless of the time, day or night. In the unlikely case of dismissal, I understand that I am responsible to pick up my child or make arrangements to have my child picked up regardless of the time or location of the event or activity. By signing this I acknowledge that I have read the guidelines and agree to pick up my child in the event of his/her dismissal.

Parent's Typed Signature

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Put Date Here

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EVENT YEAR: 2024 REVISED: 09/07/23

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REGISTRATION INFORMATION

For any events I register for, please use the following contact information.

Student Name (first, last name)

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Student Cell:

Parent understands that not giving a student cell, if they have one, puts the Student Minister/Volunteers at a disadvantage in locating or communicating to students while at events or on trips.

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Please select all that apply.

I do

Cell Provider:

Student Email

Parent, Guardian Contact Information is Required for all trips.

Parent Name (First, Last)

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Parent Cell ( - - )

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May we send text reminders?

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Please select all that apply.

Yes No

Cell Service Provider

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Parent Name (First, Last)

Parent Cell ( - - )

May we send text reminders?

Please select all that apply.

Yes No

Cell Service Provider

* Event Registration Contact Email

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This address will receive a confirmation email

The above email address will be used to send event information, packing lists, balance due statements, deadline reminders, etc.

Please use this space to communicate any special circumstances we need to be mindful of for communication issues. For example, if there is a shared custody arrangement and event information legitimately needs to be sent to 2 homes. Or if there is another relative/guardian we need to send event details to.

How do I register for events?

All registration is done online at https://lifepointechristian.net/students.

EVENT YEAR: 2024 REVISED: 09/07/23

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Permission, Liability Release & Emergency Medical Treatment Form

A. Liability Release and Permission Form

I, the undersigned parent or guardian of childs name, date below , a minor, do hereby give permission for my above named child to participate in one or more of LifePointe Christian Church Youth Ministries’ events/activities, which may include life groups, off-site service projects, out of town trips, hiking, swimming, camping and transportation by car, van or bus.

Furthermore, I give LifePointe Christian Church permission to publish, distribute, and promote any photograph, videotape or sound recording produced by the Church (its Student Minister, ministerial staff, elders, deacons, adult volunteers/sponsors) and authorize any printed material or social media posting by the Church in connection therewith. I release all claims against the Church with respect to copyright ownership, publication and right to privacy.

In consideration for allowing my child to participate in an event, I agree to release LifePointe Christian Church (and/or its Student Minister, and/or their trustees, ministerial staff, elders, deacons, adult volunteers/sponsors) from any and all liability associated with the activity. Additionally, I do hereby release and discharge LifePointe from all claims, obligations, damages 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 their child listed above.

Child's Name

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Put Date Here

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B. Emergency Medical Treatment

In the event of an emergency during an event/activity where I am not present, I, the undersigned parent or guardian of child name, date , a minor, do hereby authorize adult workers with the Student Ministry of LifePointe Christian Church to act on my behalf to consent to provide for the complete medical care of my child named above, as if I were acting for my child. Further, as a parent or guardian of the minor named above, I understand that if possible, phone contact to me will be attempted prior to any treatment. However, in the event that I am unable to be reached and timeliness of diagnosis or treatment is deemed advisable, I do hereby expressly consent that my minor child may receive emergency medical treatment from any physician, hospital, or other medical center without the necessity of first notifying me, and do further agree to hold blameless any physician, hospital or other medical center for rendering such services.

Child's Name

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Put Date Here

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I, Parent/Guardian Signature have read and agreed to the Liability Release and Permission Form (section A), and the Emergency Medical Treatment(section B) and hold that the Medical Information (section C) is truthful and accurate to the best of my knowledge. I agree that should the medical/insurance information change from what I have provided, I am responsible for updating these forms for the safety and well being of my child. I further agree that these forms shall remain in effect until the next school year or until I revoke them in writing.

Parent/Guardian Signature Here (Sections A,B,C)

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Put Date Here

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Besides assessing any special considerations your child might require during an event/activity, the information you supply on this page can be supplied to a physician or an emergency medical technician in the event of injury or illness. Please provide any additional information you believe would be relevant to an adult tasked with the care of your child.

C. Medical Information

Child's Name

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Date Of Birth

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Home Address

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Home Phone

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City/State/Zip

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EMERGENCY CONTACT: People to be contacted in case of injury or illness:

Emergency Contact

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Home Phone

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Cell Phone

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Emergency Contact

Home Phone

Cell Phone

Family Physician:

Office Address

Insurance Company

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Policy Number

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Hospital Coverage

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Please select one option.

Yes No

Parent(s) Names

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Check to indicate YES for any that apply to the participant:

Check to indicate YES for any that apply to the participant:

Please select all that apply.

1) I wear contact lenses 2) I have a sleep disorder or night terrors 3) I suffer from motion sickness 4) I am a hemophiliac 5) I have ulcers 6) I am subject to fainting spells or dizziness 7) I am diabetic 8) I have low blood pressure 9) I have or have had epilepsy or other illness that causes loss of consciousness (within the last 5 yr)

Sections 10-17 are optional, and are to be filled out at the discernment of the Parents and Guardians of the student.

These sections will better help LifePointe's Staff, Volunteers serve the needs of your child.

If not filled out, LifePointe is to not be held responsible for medical needs listed in sections 10-17.

10. I have any daily mandatory medical needs? If so, list

11. I have MEDICAL dietary needs. If so, list:

12. I have a heart condition ____ If yes, explain:

13. I have a physical handicap Explain:

14. I have an illness that is or might be contagious to others Explain:

15. I have allergies. List:

16. I have had a tetanus booster in the last 2 years

17. I have other conditions or disabilities (physical, mental or emotional) not already mentioned which might affect me or those around me on this activity/event? Explain:

18. I have included a copy, front and back, of my child’s current health insurance card. I agree that the above information about my child's health is truthful and accurate.

FRONT Copy of Child's Current Insurance Card. I agree that the above information about my child's health is truthful and accurate.

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Upload (8MB)

BACK Copy of Child's Current Insurance Card. I agree that the above information about my child's health is truthful and accurate.

Upload (8MB)

Parent's/Legal Guardian Consent of Form Use Signature

By entering my name below, I'm giving consent for this information to be used by LifePointe Christian Church. And I'm acknowledging the agreement to the terms of this medical release form.

Parent's/Legal Guardian Electronic, Full Name (First, Middle, Last)

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Put Date Here

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EVENT YEAR: 2024 REVISED: 09/07/23

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Description

Every school year, parents and students are required to submit a new SAP (Student Activity Packet) before participating in any Student Ministry event or activity. This once-a-year “red tape” enables us to provide safety and care for your child and ensure that we have current contact information for you.

This packets contains the following:
Behavior Guidelines Form
Permission/Emergency Treatment Medical Form

Please Fix the Following

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