SWAG Registration

Thank you for your interest in this program.

Please register by completing the form below.

"*" indicates required fields

Parent / Guardian Name*

First Last

Parent/Guardian Email*

Parent/Guardian Cell Phone*

Parent/Guardian Marital Status

Student's Home Address*

Street Address Address Line 2 City State ZIP Code

Student Name*

First Last

Student Cell Phone

Student Gender*

Student Date of Birth*

Grade in School*

School*

Other School

If you chose one of the "Other" School options in the previous question, please write the name of the school below.

Race/Ethnicity*

Primary Language*

Emergency Contact*

First Last

Emergency Phone*

Parent / Guardian Consent*

*I understand that while participating at Streams of Hope that my child is expected to conduct him/herself in an orderly manner. They are expected to respect the instructor and other students.

*I understand that my student will be expected to abide by the rules and code of conduct required at Streams and are at risk of losing their spot in the program, if they do not do so.

*I understand that if my child’s behavior/attitude is disruptive, they will risk removal from the program.

*I understand that regular attendance is required and if my student is absent for more than 2 weeks of programming, they will lose their spot in the program.

*I give my consent for Streams staff to access/view my student’s grades through their school’s online system.

*I give permission to the staff at Streams to communicate via text to my student’s cell phone with program related information.

*I am the legal parent/guardian of this student and do hereby consent and allow Streams of Hope, Grand Rapids, MI to handle any type of medical care for my child including but not limited to the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child is in the care of Streams of Hope and I am not reasonably available by telephone to give consent.

*I also hereby grant permission to Streams of Hope and its representatives to take photographs or videos of me, and/or my child while at Streams of Hope located at 280 60th St SE, Grand Rapids, MI 49548. I further grant producers and their representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these images and recordings in any media now known or later developed. I acknowledge that Streams of Hope owns all rights to the images and recordings.

*I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy. I also waive any right to royalties, or other compensation arising from or related to the use of the images, recordings, or materials. I hereby release, defend, indemnify, and hold harmless the producers from and against any claims, damages, or liability arising from or related to the use of the images, recordings, or materials, including but not limited to claims or defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.

I consent.

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SWAG Registration

Thank you for your interest in this program.

Please register by completing the form below.

We strive to be the hub of a vibrant, growing, empowering community where neighbors are committed to the growth of each person while maintaining our uncompromised values and love for Jesus.