Teen Week 2026 Registration Form

Who: Any students who will be entering 7th grade in the upcoming school year through students who have just graduated are welcome to come.

What: Teen Week is four evenings packed with games, food, and most importantly, a lesson from the Word of God!

Where: JIBC

When: Sunday, May 31st through Wednesday June 3rd (6-9 pm, 6-9:30 pm Wed)

Name of Teen

Birthdate

Grade Entering

7 8 9 10 11 12 New Graduate

Address

Does your teen have any of the following allergies?

Food Environmental Medication Other None of these

If your child has any of the allergies noted above, please specify them here as well as any treatment they require if they have a reaction.

Does your child carry an epi-pen?

yes no

Does your child have any other medical/other conditions that we need to be aware of?

Communication Permissions and Information

Email will be the PRIMARY source of communication we will have with your family. These emails will be related to IMPACT and will provide information you and your teen/s may need to know about weekly activites, dates IMPACT will not meet, special events and activites, and information about the things your teen/s are studying. If you prefer not to receive these emails, please remember that you may not have the most accurate information about what is happening on Wednesday evenings.

Name of Parent/s or Guardian

Primary guardian email:

This address will receive a confirmation email

Secondary guardian email:

This address will receive a confirmation email

Can we communicate important IMPACT updates and information with your teen through their own e-mail address?

Yes No

Email of Teen

We will never "spam" or send you needless text messages. We will use a text communication method for weather-related closings, emergencies, or important reminders/updates. If you desire not to receive text messages, we will do our best to respect that choice. May we send you text messages?

Yes No

Primary guardian cell phone number:

Primary guardian relationship to teen:

Secondary guardian cell phone number:

Secondary guardian relationship to teen:

Can we communicate important IMPACT updates and information with your teen's personal cell phone via text?

Yes No

Teen's Cell Phone

Medical Permission

As the parent/guardian of the child(ren) named, I do hereby authorize treatment of the child(ren) named on this form in the event of a medical emergency that may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted ONLY after a reasonable effort has been made to reach me by phone at the number(s) listed above. I assume the responsibility of any cost connected with such treatment and hereby release Johnstown Independent Baptist Church, 7397 Johnstown-Alexandria Road, Johnstown, OH 43031, from any liability for any accident, injury, or costs that may occur. This release form is completed and accepted of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.

Yes No

Media Permission

JIBC periodically receives attention from local newspapers about our AWANA and/or IMPACT programs. We ourselves take pictures of children and activities to use on our Facebook page, website, or occasionally a printed flyer. We need a legal guardian’s permission to do these things and ask you to respond to this information. If you choose not to grant permission, this will in no way affect any child’s opportunity to participate in programs or events. So that we can honor your wishes, mark the box indicating your choice. Please call if you have questions or concerns at 740.967.7417.

Yes No

Transportation Permission

I do hereby authorize member van drivers of JIBC or IMPACT leaders to transport my child(ren), listed above, to and from IMPACT ministries or activities. I release Johnstown Independent Baptist Church, 7397 Johnstown-Alexandria Rd., Johnstown, Ohio, from any liability for accident or injury incurred from transportation in our church van or member vehicles..

Yes No

Teen Week 2026 Registration Form

Description

Please Fix the Following