2022-23 YOUTH REGISTRATION FORM 1Parent Information2Student #1 Information3Student #2 Information4Student #3 Information5Consent Information How many students in your household are you registering?OneTwoThreeFamily Home PhoneMother's Name First Last Mother's Email Mother's Cell PhoneFather's Name First Last Father's Email Father's Cell PhoneFamily Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Family Church Affiliation Emergency Contact (other than parent) First Last Emergency Contact's Relationship to Student Emergency Contact Phone Student #1 Name* First Last Student #1 Cell PhoneStudent #1 Date of Birth* MM slash DD slash YYYY Student #1 Gender* Male Female Who does student #1 live with?Both Mom & DadMomDadOtherStudent #1 School* Student #1 Grade (for the 2022-23 School Year)*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeStudent #1 Food Allergies: Student #1 Special Needs or DisabilitiesWhat is your preference for drop-off and pick-up for Student #1? Please check only one.* PERMISSSION TO ARRIVE/DEPART WITHOUT ADULT SUPERVISION: As the parent/guardian of the child named above, I give consent to the leadership of the activity to allow my child to arrive and depart from youth group activities without the supervision of a parent or guardian. I give consent to allow my child to sign in and sign out of activities as they will be traveling to the activity without a parent/guardian. I understand my child DOES NOT have permission to leave prior to the conclusion of the activity for any reason unless pre-approved by the parent/guardian and verbal or written notification given to the leadership of the activity. PARENT/LEGAL GUARDIAN DROP OFF/PICK UP: As the parent/guardian of the child named above, I will drop-off and pick-up my child for each activity. If I am unable to drop-off and pick-up my child, I will inform the activity leadership of the person I give permission to drop off/pick up my child or children. Furthermore, I will sign my child in and out of activities as required by activity leadership. Student #2 Name (Click NEXT if this page if not applicable) First Last Student #2 Cell PhoneStudent #2 Date of Birth MM slash DD slash YYYY Student #2 Gender Male Female Who does Student #2 live with?Both Mom & DadMomDadOtherStudent #2 School Student #2 Grade (for the 2022-23 School Year)*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeStudent #2 Food Allergies: Student #2 Special Needs or DisabilitiesWhat is your preference for drop-off and pick-up for Student #2? Please check only one.* PERMISSION TO ARRIVE/DEPART WITHOUT ADULT SUPERVISION: As the parent/guardian of the child named above, I give consent to the leadership of the activity to allow my child to arrive and depart from youth group activities without the supervision of a parent or guardian. I give consent to allow my child to sign in and sign out of activities as they will be traveling to the activity without a parent/guardian. I understand my child DOES NOT have permission to leave prior to the conclusion of the activity for any reason unless pre-approved by the parent/guardian and verbal or written notification given to the leadership of the activity. PARENT/LEGAL GUARDIAN WILL DROP OFF/PICK UP: As the parent/guardian of the child named above, I will drop-off and pick-up my child for each activity. If I am unable to drop-off and pick-up my child, I will inform the activity leadership of the person I give permission to drop off/pick up my child or children. Furthermore, I will sign my child in and out of activities as required by activity leadership. Student #3 Name (Click SUBMIT if this page is not applicable) First Last Student #3 Cell PhoneStudent #3 Date of Birth MM slash DD slash YYYY Student #3 Gender Male Female Who does Student #3 live with?Both Mom & DadMomDadOtherStudent #3 School Student #3 Grade (for the 2022-23 School Year)*6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeStudent #3 Food Allergies: Student #3 Special Needs or DisabilitiesWhat is your preference for drop-off and pick-up for Student #3? Please check only one.* PERMISSION TO ARRIVE/DEPART WITHOUT ADULT SUPERVISION: As the parent/guardian of the child named above, I give consent to the leadership of the activity to allow my child to arrive and depart from youth group activities without the supervision of a parent or guardian. I give consent to allow my child to sign in and sign out of activities as they will be traveling to the activity without a parent/guardian. I understand my child DOES NOT have permission to leave prior to the conclusion of the activity for any reason unless pre-approved by the parent/guardian and verbal or written notification given to the leadership of the activity. PARENT/LEGAL GUARDIAN WILL DROP OFF/PICK UP: As the parent/guardian of the child named above, I will drop-off and pick-up my child for each activity. If I am unable to drop-off and pick-up my child, I will inform the activity leadership of the person I give permission to drop off/pick up my child or children. Furthermore, I will sign my child in and out of activities as required by activity leadership. Student Code of Conduct* As a parent/guardian of a youth in the BBC Youth Group, I have prayerfully read and understand the BBC Youth Group Code of Conduct. I support the Youth Code of Conduct and expect my child to adhere to it at all times.Whatever you do in word or deed, do all in the name of the Lord Jesus, giving thanks through Him to God the Father. (Col. 3.17) We are pleased to have you as a participant in our ministry! Whether you are a member of Ballardsville Baptist Church or a guest, our Youth Group Code of Conduct is based on the expectation that we will conduct ourselves in a Christian manner during all activities (i.e. at all church event, riding in vehicles, retreats, service projects, etc.) The following is a statement of conduct to be read and agreed to by your signature. Your parent(s)/guardian are also to read and verify that you understand these policies of conduct and are agreed to by their signature. Electronic Devices: Use of Electronics is a privilege, not a right, and will only be allowed under certain conditions. If use of devices (phones, devices, tablets, computers, etc.) gets in the way of relationships, the spirit of the activity/trip/camp, or sleep/health, it is entirely within the rights of the Youth Leaders/Chaperones to confiscate the device for any amount of time deemed appropriate, including the duration of the event or trip. The device may be returned to the parents after the event with a conference (consisting of the Youth leader, parent[s], and youth). Respect of People: Youth must respect, listen to, and cooperate with all adult Youth Leaders and drivers, as well as fellow youth. Bullying, harassment, unkind speech, and intimidation will not be tolerated. Negative talk, put downs, and disrespect are not allowed. Harassment, intimidation, or bullying can take many forms including: slurs, rumors, jokes, innuendo’s, demeaning comments, drawing cartoons, pranks, gestures, physical attacks, threats, social media posts, or other written, verbal, or physical actions. Respect of Property: Youth will respect the facility where the activity takes place, others’ property and their own. Students that are involved in the act of breaking something will be expected to repair/replace the damaged item(s) at his/her expense. Any form of stealing or using others property without their approval or knowledge will not be tolerated. Youth are also expected to clean up any messes they make, especially when eating or drinking. Safety: Do not leave the group or building without permission from Youth Leaders. Participation: We expect our Youth to come and participate in the spirit of the event and have the opportunity to grow in Christ and in relationships with each other and with Christian adults. We will not accept behavior that interferes with the full participation of others’ education or growth. This includes unnecessary disruptions (ie: getting up from your seat, talking when others are talking and frequent requests for bathroom breaks). Youth are expected to participate willingly in the planned activities. Youth are here to develop and explore a growing relationship with Christ and others. There will be times that are fun and crazy, and times that are structured learning environments. This is very intentional and will not be disrupted. Character: We believe in the Christian standard of character, and expect our Youth to avoid profanity, put-downs, stealing, arguing, exhibiting improper behavior, using alcohol or illegal substances, using tobacco products or vaping, possession of unauthorized drugs, possession of weapons (including pocketknives), and dishonesty. (Note: If you need to take a medication, it must be brought in by a parent/guardian and given to the Youth Leader with a note of permission to dispense.) We will speak in a kind manner and work out our differences in a peaceful, respectful, and non-violent manner, involving Youth Leaders/Adults whenever help is needed. Inappropriate displays of affection (kissing, excessive cuddling, or any action sexual in nature, are NOT permitted during any BBC Youth Group activity or event. We expect Youth to dress in appropriate, modest, and undistracting ways and comply with any directive to cover up by Youth leaders. Failure to comply with the Youth Code of Conduct: Depending on the severity of the behavior, we will follow a 3-step process. Note: If the severity of the offense dictates it, the church leadership reserves the right to send the person(s) home who are intentionally oppositional or repeatedly refuse to follow the Youth Code of Conduct policy mentioned above for any BBC or Youth Event without warnings. Step 1) Verbally correct the behavior, along with removal from the situation, removal of a device, separation, etc., as appropriate. Pastors/Elders will be notified if not already involved. Step 2) If another or the same behavior contrary to our Youth Code of Conduct occurs involving the same person, especially when it is considered to be occurring in a destructive, attention-getting, or belligerent fashion, then a second warning will be given, accompanied by a call to the parent(s) from the Youth Leader and/or the Pastor/Elder. Step 3) Should there be a third problem behavior contrary to our Youth Code of Conduct, the parent(s)/guardian will be called immediately and asked to come and get their Youth, or in the case the Youth drives themselves, the parent(s)/guardians will be notified that their Youth has been sent home due to continuous violations of the Youth Code of Conduct. A conference will be scheduled for the Youth leader, a Pastor/Elder (if different from the involved Youth leader), parent, and the youth involved to resolve the conflict after the activity/trip is concluded. This conference must take place before the youth will be allowed to return to any Youth Group activities.Photo Consent* I agree to the photo consent.I authorize that my child's image may be photographed or filmed and used in Ballardsville Baptist Church (BBC) video presentations, youth ministry social media, and the BBC website.Parent/Legal Guardian Signature: By typing your name, you agree that the information on this form is correct to the best of your knowledge. CAPTCHA Δ