Elevate Student Ministries

Parents/Guardians please fill this form out with YOUR information first. Click "Add adult" to add your spouse's information. Click "Add child" to enter their information. You can add as many students as you need to.

Your name *

Email address *

Address *

Phone number *

Your Preferred Method of Communication *

Texting

E-mail

Household members

Media Consent/Permissions

I hereby grant Dayspring Assembly of God (the Church) permission to use my child’s likeness in photographs, video recordings or electronic images in any and all of its publications, including websites, Facebook or other social media. I hereby irrevocably authorize the Church to edit, alter, copy, exhibit, publish or distribute these images for purposes of publicizing the Church's programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my child’s likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image. I hereby hold harmless and release and forever discharge the Church from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this use.

Yes, I consent to the above media permissions for my child(ren)

No, I do not consent to the above media permissions for my child(ren)

Please list all authorized people to drop off/pick up your student(s)

List as many names as possible