Apex Signup – Restoration Anglican Church

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APEX Registration

Register your student for Apex 2023-2024.

Apex Registration Form

Step 1 of 3

33%

Participant Name*
Participant Email*
Participant Birth Date*
MM slash DD slash YYYY
What school does your child attend?*
Grade Level*
- 6th
- 7th
- 8th
- HS Freshman
- HS Sophomore
- HS Junior
- HS Senior
What size t-shirt is your student?*
- Small
- Medium
- Large
- XL
Adult sizes listed.
May APEX leaders initiate email/text/phone conversations with Participant 1?*
- Yes, per the guidelines below, I am comfortable with my student's small group leaders and Apex staff initiating electronic communication with my student
- Yes, but please include me on any communication pertaining to making plans outside of Apex
- Yes, but include me on any and all communication between leader(s) and my student
- No, I am not comfortable with my student's small group leaders or Apex staff initiating any electronic communication with my student
As part of our small group ministry to students, we seek to foster good, healthy, and safe patterns of communication between both leaders (including Apex staff and Apex volunteer small group leaders) and students. To that end, there are the following guidelines for electronic communication between leaders and students: Apex leaders (including Apex staff and Apex volunteer small group leaders) may initiate email/text/phone conversation with a student when permission has been granted by the student’s parent or guardian. Only Apex leaders of the same gender may initiate an email/text/phone conversation with a student (i.e. Female Apex leader to Female Apex student). If a student reaches out directly to an Apex leader who is of a different gender, that leader will always copy another Apex leader of the same gender as the student in their reply to that student. By answering this question, you can indicate to Apex staff and volunteers how you prefer they communicate with your student outside of Apex.
What is Participant 1's phone number?*
Do you need to register another participant?
- Yes
- No
Participant 2
Participant 2 Name*
Participant 2 Email*
Participant 2 Phone (if applicable)
Participant 2 Birth Date*
MM slash DD slash YYYY
What school does Participant 2 attend?
Grade Level*
- 6th
- 7th
- 8th
- HS Freshman
- HS Sophomore
- HS Junior
- HS Senior
What size t-shirt is your student?*
- Small
- Medium
- Large
- XL
Adult sizes listed.
May APEX leaders initiate email/text/phone conversations with Participant 2?*
- Yes, per the guidelines below, I am comfortable with my student's small group leaders and Apex staff initiating electronic communication with my student
- Yes, but please include me on any communication pertaining to making plans outside of Apex
- Yes, but include me on any and all communication between leader(s) and my student
- No, I am not comfortable with my student's small group leaders or Apex staff initiating any electronic communication with my student
As part of our small group ministry to students, we seek to foster good, healthy, and safe patterns of communication between both leaders (including Apex staff and Apex volunteer small group leaders) and students. To that end, there are the following guidelines for electronic communication between leaders and students: Apex leaders (including Apex staff and Apex volunteer small group leaders) may initiate email/text/phone conversation with a student when permission has been granted by the student’s parent or guardian. Only Apex leaders of the same gender may initiate an email/text/phone conversation with a student (i.e. Female Apex leader to Female Apex student). If a student reaches out directly to an Apex leader who is of a different gender, that leader will always copy another Apex leader of the same gender as the student in their reply to that student. By answering this question, you can indicate to Apex staff and volunteers how you prefer they communicate with your student outside of Apex.
What is Participant 2's phone number?*
Do you need to register another participant?
- Yes
- No
Participant 3
Participant 3 Name*
Participant 3 Birth Date*
MM slash DD slash YYYY
Participant 3 Email
What school does Participant 3 attend?*
Grade Level*
- 6th
- 7th
- 8th
- HS Freshman
- HS Sophomore
- HS Junior
- HS Senior
What size t-shirt is your student?*
- Small
- Medium
- Large
- XL
Adult sizes listed.
May APEX leaders initiate email/text/phone conversations with Participant 3?*
- Yes, per the guidelines below, I am comfortable with my student's small group leaders and Apex staff initiating electronic communication with my student
- Yes, but include me on any and all communication between leader(s) and my student
- Yes, but please include me on any communication pertaining to making plans outside of Apex
- No, I am not comfortable with my student's small group leaders or Apex staff initiating any electronic communication with my student
As part of our small group ministry to students, we seek to foster good, healthy, and safe patterns of communication between both leaders (including Apex staff and Apex volunteer small group leaders) and students. To that end, there are the following guidelines for electronic communication between leaders and students: Apex leaders (including Apex staff and Apex volunteer small group leaders) may initiate email/text/phone conversation with a student when permission has been granted by the student’s parent or guardian. Only Apex leaders of the same gender may initiate an email/text/phone conversation with a student (i.e. Female Apex leader to Female Apex student). If a student reaches out directly to an Apex leader who is of a different gender, that leader will always copy another Apex leader of the same gender as the student in their reply to that student. By answering this question, you can indicate to Apex staff and volunteers how you prefer they communicate with your student outside of Apex.
What is Participant 3's phone number?*

Parental Permission and Medical Authorization Form
Parent or Guardian Name*
First Last
Email*
Home / Cell Phone*
Work Phone
Would you like to add an additional parent or guardian?
- Yes
- No
Additional Parent or Guardian
Parent or Guardian Name*
First Last
Email*
Home / Cell Phone*
Work Phone
Emergency Contact*
First Last
Emergency Contact Phone Number*
Relationship to Participant*
General Permissions
I give permission for my child(ren) to attend the events, field trips, and service projects associated with Restoration Anglican Church's Youth Group (APEX) of Arlington, Virginia. I further give permission for my child(ren) to be transported to and from events by hired and volunteer drivers authorized by Restoration Anglican Church.*
- Yes
- No
By choosing "no," your child(ren) will only be able to participate in activities that take place at Restoration Anglican Church. Please keep in mind that throughout the course of the year, there are many activities, service projects and events that take place off-site.
I further give permission for my child to participate in all supervised activities except as noted:
You can address the needs of each child in this section; just please clearly state which one you're speaking about.
I give permission for pictures/videos, in which my child appears as a program participant, to be used in APEX brochures, flyers, social media, and/or other promotional materials published and distributed by Restoration Anglican Church.*
- Yes
- No
Medical Release
In the event of an emergency, I hereby authorize the Restoration Anglican Church Youth Group leaders, hospitals, licensed medical or dental providers, and their agents and employees to have access to the information contained in the form and to provide all medical or dental care, routine tests, treatment, and necessary transpiration advisable for the health and safety of my child. This authorization includes the authority to consent to any x-ray examinations, imaging, anesthetic, medical procedure or treatment, and hospital care under the supervision, and upon jurisdiction where the medical services are being rendered to my child.*
- Yes
- No
If you have multiple children and would like to exclude just one from the above agreement, or have a unique situation, please email apex@restorationarlington.org to reach APEX staff.
I further authorize the Restoration Anglican Church Youth Group leaders to receive physical custody of my child upon completion of any treatment, and I specifically instruct any treating health facility to surrender physical custody of my child to said adult.*
- Yes
- No
If you have multiple children and would like to exclude just one from the above agreement, or have a unique situation, please email apex@restorationarlington.org to reach APEX staff.
Initials*
Today's Date*
MM slash DD slash YYYY

Is the participant under a healthcare plan?
- Yes
- No
Health Care Information
Physician Name
First Last
Physician Phone
Medical Insurance Company
Policy/Group Number
Agreement
In consideration of Restoration Anglican Church determining the need for, and type of, diagnosis, treatment, or medical care (if any), I/We release Restoration Anglican Church from any and all liability whatsoever for bodily injuries, property damage, or other claims sustained during or related to the diagnosis, treatment, and medical care. I/We also agree to indemnify Restoration Anglican Church and/or its agents for, and hold Restoration Anglican Church and/or its agents harmless from, any and all claims or suits brought by any person or entity to the extent of any and all costs, expenses, damages, judgments, verdicts, and/or attorneys’ fees.*
- Yes
- No
By selecting "no," there will be some off-site activities your child will not be able to participate in.
Allergy, Medication, and Limitation Disclosure
Please list any allergies to drugs, foods, plants, insects, etc that the participant(s) may have:
Please list these for each child if you have multiple.
Please list any prescription medication to be taken by the participant(s) (Including what it is taken for, when it is to be taken, dosage information, and any special procedures):
Please list these for each child if you have multiple.
Please list any non-prescription (over-the-counter) medication you do NOT want dispensed to the participant(s):
Please list any additional information relevant to participating in Restoration Anglican Church Youth group activities (dietary needs; surgeries or serious injuries; chronic of recurring illness; medical conditions such as epilepsy or diabetes; psychiatric counseling or indications, etc.):
Please list these for each child if you have multiple.

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