This form is for students in Grade 6 to 8.

Student Information


Contact Information


*Mailing Address only required if different from home address


Parent Information

*If you have already registered a child for IMPACT or IGNITE this year, you may omit this section. 


Liability & Release Waiver

Do you give permission for the reasonable use of pictures and/or video containing your child on our SBC website or related social media sites?


I understand and accept that my child(ren) will be involved in a variety of age-appropriate games and activities through which injuries could occur. I, the parent/guardian named below, understand the risks associated with these activities.


I understand and accept my child(ren) may be involved in off-site events and activities (bowling, swimming (pool & beach), park wide games, go karting, hiking, lazer tag etc.)  through which injuries could occur. I, the parent/guardian named below, understand the risks associated with these activities.


In case of accident or illness, I, the parent/guardian named below, authorize an SBC staff person to contact a physician and/or ambulance. I accept responsibility for payment of ambulance fees.


I, the parent/guardian named below, undertake and agree to indemnify and hold harmless Summerland Baptist Church, its Ministry Personnel, Pastors and Leadership Board from and against any loss, damage or injury suffered by the participant as a result of being part of IMPACT Youth as well as any medical treatment authorized by the supervising individuals representing the Church.


By selecting the "I Accept" button below, you are signing this Agreement electronically and you agree your electronic signature is the legal equivalent of your manual signature on this Agreement. 

Tip: If you select 'I Do Not Accept' we will require you to print and sign this document and bring it in to the church office before your registration can be completed.