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Please complete the registration form to enroll your child into any child or youth ministry group at Shiloh Baptist Church. The form is programmed into 4 sections. A parent will need to complete the required fields on each page before being allowed to move to the next page and/or submit the form. The 4 sections are: (1) Childen/Youth participant information; (2) Parent/Legal Guarddian Contact and Authorized Pickup Information; (3) Select Child & Youth Ministry Groups; and (4) Consent/Waiver/Release. Please contact Angela Freeman if you have additional questions about this form.
Child's/Youth's First Name
Child's/Youth Last Name
If none, write not applicable
If none, type not applicable
Regardless of relationship, no child will be released from a ministry activity into the care of an adult other than the authorized pick-up person as designated on this form.
Pull Shiloh verbiage or standard used at other church.
By selecting "Yes" to this question, I (or parent/guardian if participant is a minor) certify that I have read and agree to the terms of the Participant/Liability Agreement.
I hereby authorize Shiloh Baptist Church (SBC) to publish the photographs and videos taken of me and/or the undersigned minor children, and our names, for use in the Shiloh Baptist Church's printed publications, website and training purposes for the Children and Youth ministries.
I release Shiloh Baptist Church from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed above and that I have the authority to authorize the Shiloh Baptist Church to use their photographs, videos and names.
I acknowledge that since participation in publication, videos and websites produced by Shiloh Baptist Church is voluntary, neither the minor children nor I will receive financial compensation.
I further agree that participation in any publication, videos and website produced by Shiloh Baptist Church confers no rights of ownership whatsoever. I release Shiloh Baptist Church, its contractors, officers, agents, employees, successors, licensees and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children. I understand and agree to the conditions outlined in this photograph, video and sound recording release and consent form for minor children. I irrevocably give consent to Shiloh Baptist Church’s officers, agents, employees, successors, licensees, and assigns forever to make use of my image, likeness, appearance, and voice in photographs, video and sound recordings as described above. I acknowledge that I am fully aware of the contents of this release and am under no disability, duress, or undue influence at the time of my signing of this instrument.
By selecting "Yes" to this question, I (or parent/guarding if participant is a minor) certify that I have read and agree to the terms of the Standard Photo and Video Release Form.
This field is not part of the form submission.
* indicates a required field