Love, Joy, Peace...
Name (Required)
Email Address (Required)
Student Name (Required)
Parent/Guardian Name (Required)
Emergency Contact (Required)
In the event of an emergency, who do we contact? Phone number?
Allergies or Medical Info (Required)
I give my permission for my student to attend and participate in all Cleveland Assembly of God Youth activities, events, services, off-site trips, and transportation.
If an emergency happens and I cannot be reached, I authorize Cleveland Assembly of God staff or approved adult leaders to seek medical attention for my student. I accept full responsibility for all medical expenses.
I understand that my student may be transported by church staff or approved adult volunteers in church vehicles or personal vehicles. I release Cleveland Assembly of God, its leaders, volunteers, and representatives from liability related to transportation to and from events.
I permit Cleveland Assembly of God to use photos or videos of my student for church-related media, including social media, slides, and promotional materials. No compensation will be provided.
I understand my student should show respect, follow instructions, and behave Christ-honoring at all events. If behavior is unsafe or disruptive, I may be asked to pick up my student.
Parent/Guardian Approval (Required)
This permission remains in effect until revoked in writing by the parent or guardian.
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Our Mission
We invest in people, impart the truth of God’s word, involve every person in purpose, and increase the reach of God’s kingdom through Spirit-empowered living.
 
Cleveland Assembly of God
508 W. Miami Ave.
Cleveland, OK 74020
918-358-3275
 
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