Dove Bible Club * P.O. Box 111530 * Palm Bay, Fl 32911   

                    www.DoveBibleClub.org

Student Registration 2020/2021 School Year
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Parent Information
Parent Information (Required)
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I Can Help Dove Bible Club By....    (Click All That Apply)
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Child Pick Up and Transportation
Please list up to 3 authorized pick up people. Driver's License MUST be presented at time of pick up.
Children will not be released to an unauthorized pick up person.
If there is an issue, only the Parent(s) will be contacted
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Child Information
Child #1                                                                                               
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Child #2                                                                                               
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Child #3                                                                                               
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Child #4                                                                                               
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Child #5                                                                                               
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                                                   Photo Release                                                            

REQUIRED

By filling out this registration form for Dove Bible Club, I AGREE THAT I AM GIVING PERMISSION FOR PHOTOGRAPHS OF THE STUDENT(S) listed above to be used in publications of Dove Bible Club, Inc (including but not limited to the Dove Bible Club website, Dove Bible Club Social media pages and/or groups). I understand that these photos may be viewed by anyone but no identifying information will be displayed.  
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                                                 COVID-19 Wavier                                                         

COVID-19 and Voluntary Meetings - School Year 2020-21

I desire to participate or allow my child(ren) to participate in one or more voluntary extracurricular activities sponsored by Dove Bible Club, Inc. The novel coronavirus known as COVID-19 has been declared as a worldwide pandemic and is believed to be contagious and spread by person-to-person contact. Federal, state, and local agencies recommend social distancing and other measures to prevent the spread of COVID-19.

Dove Bible Club, Inc (DBC) will conduct monthly meetings beginning in the 2020-21 school year. These meetings, hereinafter known as “Meetings,” will be conducted with safety protocols appropriate under the circumstances at the time. For the safety of all people involved, participants in the Meetings will be required to adhere to all safety protocols and are subject to immediate removal from the Meetings if they do not comply. Extracurricular activities are a privilege, and not a right, of public school students.

In an effort to ensure the safety and wellness of our school community, I understand the importance of students being healthy and safe when they participate in the Meetings. By signing below, I agree that I will:

  • Perform daily temperature checks on my child(ren) to screen for fever before arrival for the Meetings. Fever is defined as a temperature over 100 F. If my child(ren) has a fever, I will not permit my child(ren) to participate in the Meetings until he/she has been without a fever for at least 72 hours.
  • Make a visual inspection of my child(ren) for signs of illness which could include: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, flushed cheeks, rapid breathing or difficulty breathing (without recent physical activity), fatigue, or extreme fussiness. If my child(ren) has exhibited any of these signs or symptoms, I will not permit my child(ren) to participate in the Meetings until he/she has been without signs or symptoms for at least 72 hours.
  • Confirm that my child(ren) has not been in contact with someone who has either tested positive for COVID-19 in the past 14 days or is waiting for test results. If my child(ren) has been in contact with such a person, I will not permit my child(ren) to participate in the Meeting  until 14 days have elapsed since the time of contact.
  • Promptly pick up my child(ren) or arrange for pickup if signs or symptoms of illness are present. I understand that children are to remain home until illness-free for at least 72 hours without the use of medicine.

By signing this document below, I acknowledge and affirm all of the statements above. I also voluntarily assume all risks that I and/or my child(ren) may be exposed to or infected by COVID-19 as a result of participation in the Meeting, and that such exposure or infection may result in personal injury, illness, sickness, and/or death. I understand that the risk of exposure or infection may result from the actions, omissions, or negligence of myself, my child(ren), DBC volunteers, or agents, other Meeting participants, or others not listed, and I acknowledge that all such risks are known to me.

In consideration of me and my child(ren) being able to participate in the Meetings, I, on behalf of myself, as well as anyone entitled to act on my behalf, hereby forever waive, release, and hold Dove Bible Club, Inc, and its volunteers and agents harmless from any and all claims, suits, liability, actions, judgments, attorneys’ fees, costs, and any expenses of any kind resulting from injuries or damages, grounded in tort or otherwise, that I and/or my child(ren), or my or our representatives, sustain during or related to my child(ren)’s participation or involvement in the Meetings.

REQUIRED

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Stay Informed
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