Defined Check-In Zoom Classes

“DEFINED” REGISTRATION FORM

The purpose of the six weeks session is to help young people realize their true identity in Christ and learn strategies to handle real-life issues that may hinder them from knowing who they are in Christ. These sessions are inspired by the book, “Defined: Who God Says You Are” by Stephen & Alex Kendrick.

These sessions may expose root of some issues that your child may be currently facing, which will provide an opportunity for healing. Any information your child shares is confidential unless your child gives written consent to disclose certain information. Because of the sensitive nature of the information being discussed, confidentiality is essential to preserve your child’s basic rights and trust. During these sessions, your child has the right to:

Be respected, listened to, and heard.
Freely express your thoughts, feelings, and emotions in a safe and judgment-free space.
Confidentiality under federal and state laws.
Humane care and protection from harm, abuse, and neglect.
Make an informed decision regarding whether to accept or reject help.

While your child’s safety and privacy are important to us, there are some situations where information may need to be disclosed. They include:

The child harms oneself or someone else.
The child is involved in activities, causing harm to oneself, someone else, or national security.
The child reports abuse of oneself or an elderly person
A court subpoena
The child signs a waiver requesting the release of information.

Except for the situations described above, the child’s parent(s)/guardian(s) will not be told specific information the child shares in the sessions. This includes activities/behaviors the child’s parent(s)/guardian(s) would not approve of or maybe upset by, but do not put the child or others at risk for immediate harm.

Attendance Policy

If you know you are unable to make a session, we require at least 24 HOURS notice. Each child must report to the class on time every Sunday. **If your child misses more than (3) sessions, they will not be allowed to continue participating and will need to register for any future offerings.**

Session Rules

Your child is required to follow these rules while attending these sessions:

Respect the opinions of others
Turn off or mute your phone while in session
Come to the session with an open mind, seeking to gain something
Verbal participation
Keep confidentiality

**Failure to adhere to these rules is also caused for dismissal from the session. Please review these rules with your child.**

Read and provide a check next to each statement below:*

I/We give my/our child permission to participate in the sessions, “Defined: Who God Says You Are.”

I/We have read and understand the dynamics of the six week course.

I/We understand & agree to adhere to the attendance policy, the basic rights of the child, and the limits of confidentiality stated above.

I/We have read & understand the session rules and the reasons for terminating a student from the sessions.

Student Information

Gender*

Female

Male

Date of Birth*

Age*

Name*

Address*

Home Phone*( ) -

Student Cell Phone (if any)*( ) -

Student's Email*

Grade*

Name of School/College*

Special Health Concerns

Medical Insurance Information

Membership Status*

Member

Non-Member

I'm currently in New Members' class

Parent/Guardian Information

Parent(s) Name*

Work Phone*( ) -

Cell Phone*( ) -

Parent Email Address*

Emergency Contact*

Please list name and telephone.

By signing this form, I request that my son/daughter/self (NAME REGISTERED) be allowed to participate in the “Defined” sessions for six consecutive weeks. In the event of illness or injury, I, as the parent/self, do hereby consent to whatever medical treatment is necessary.

Student Signature *

Age*

Date*

Parent/Guardian Signature*

(Required if student under 18)

Date*

Please leave this field blank.

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