2016-17 Student Registration

Please complete this Information Form (1 for each child in your household) to help CSM keep its records up to date. Thanks, Pastor Kirk

  • Parents' or Guardian

  • Emergency Contact Name/Phone (Other than parent/guardian):

  • Photos and video will be taken and shared during activities through bulletin boards, the church website and other promotional materials with our church family. At no time will names or personal information be shared concerning who is a part of the group nor in a photograph. If you would allow your child to be photographed for this purpose, please initial here:
  • We realize that no activity is without the possibility of unforeseen hazards which could result in injury to an individual. As a parent or guardian, you are to be aware of your responsibility to instruct your child of the importance of conduct which will insure safety and enjoyable time while participating in this activity. By signing this form, you, as a parent, guardian or other responsible party, agree to assume the risks and hazards which are inherent in this kind of activity. You also agree to absolve and hold harmless the sponsoring organizations and their representatives for damage, loss or injuries to the child for whom you sign.

    I give my child permission to participate in this activity, and give my permission to the leaders of this function to authorize any treatment deemed necessary by a licensed physician due to accident or illness during this activity.

    (For all activities away from the church premises, a medical
    release/covenant of conduct form must be on file with CSM (see the link on
    the CSM page). Please attach a copy of your child’s insurance card to the
    printed form.)

  • By entering your name here you are authorizing this with a digital signature.