GEMS 2024-25 Registration

Interested in trying out GEMS before committing? Join us for a week or two to see what GEMS is all about! Completed registration is requested by the third meeting you/your daughter attends. Email questions to gems@portagechapel.com. We hope to see you soon!

GEMS membership dues are $30 per member annually and may be paid with credit/debit card through this online form. If you need to discuss payment with a GEMS leader, please select the Scholarship Option when registering and provide details in the space provided.

GEMS Member Name

Member Birthdate

Member Category

Member phone number (this number will be included in the GEMS member directory)

Member School Name (if youth)

Membership Dues

If you selected the scholarship option, please describe the need below and a member of the leadership team will reach out to discuss options.

Family Information

Parent/Guardian Name ("self" if adult)

This address will receive a confirmation email

Mailing Address

Primary phone

Name of church attended, if any

Medical/Health Information

Emergency Contact Name

Relationship to member

Emergency Contact phone

Please list any health issues that may affect the activities, food consumption, well-being or medical treatment of the listed GEMS member, e.g. conditions like asthma, a physical handicap, allergies, heart condition. Also indicate any medications the registrant may be taking.

Adults: print, complete, and submit a PCC background check permission form to GEMS leadership in order to be involved with GEMS activities. If you have completed this form for PCC in the past, background checks are good for 3 years from the last submission date.

Check your confirmation email for form link.

Permissions

Permissions: I give permission for my child to be transported by GEMS leadership when an activity is away from the club location. I give permission for my child to leave the club location with GEMS leaders for special events. I give permission for my child's photo/video to be taken and used for GEMS media and promotions of the club and for her first name only to be used in identifying her. I give permission for my child's GEMS leader to contact my child via text, Band, and/or Remind message.

I give permission for these adults to pick up my child (if youth)

Portage Community Chapel and its representatives may take and use photos, videos, or other imaging formats of children and adults participating in PCC-affiliated ministries and activities. Participation in these activities constitutes agreement for use of such images for website, facebook, advertising, and other related purposes.

Every activity sponsored by Portage Community Chapel is carefully planned and adequately supervised. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, I agree to assume and accept all risks and hazards inherent in church-related social activities, both at the church and other locations selected by the church. I also agree not to hold this church or its employees or volunteer assistants liable for damages, losses or injuries to the person or property of the participating members listed above. Every attempt will be made to contact a child's parent or emergency contact I have listed on this form. However, if I/they cannot be located, I hereby give my permission to the physician or dentist selected by the church leadership to secure proper medical treatment for myself or my child, as deemed necessary. I understand that my electronic signature below is both a medical and liability release.

Full Name

Date

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

GEMS 2024-25 Registration

Description

Please Fix the Following