BD Chapter Participant Intake

Annual Chapter Registration: Why it Matters

We require annual re-registration for everyone’s safety.

  • Current Information is Key: We need the latest details (emergency contacts, allergies, health concerns) for rapid, effective response and legal compliance.
  • New Form Every Year: A fresh 2026 form is required for all attendees, regardless of prior registration. This keeps our records accurate and simplifies the process.
  • Updates: If details change mid-year, please submit a new form immediately to keep our safety information current.

STM Beaver Dam Chapter Annual Meeting Participation Form

📋 This registration form must be completed by ALL individuals attending an STM Chapter Meeting.
Participant Name
⚠️ Important Note: If you are participating as an individual with a disability, you must select 'Guest' for the following question, even if another category applies. This ensures we collect the required participation data.
Participant Role: How will you be participating in this meeting/activity/program (pick one)?
I would like to receive communications on upcoming Chapter events by:
Email
Enter your birthday below.

Health Concerns

⚠️ Special Touch Ministry Chapters DO NOT provide Personal Care Support during Chapter Meetings or Events. This includes but is not limited to eating, using the toilet, hand or mouth hygiene, catering to dietary needs, or medication management/dispensing. If personal care is needed, participant needs to provide their own Caregivers or Personal Care Staff.
Will this person be bringing an epi-pen and/or rescue inhaler to Chapter meetings or events?

Waiver & Terms of Participation

IMPORTANT WAIVER TEXT

PARTICIPANT OR THEIR LEGAL GUARDIAN UNDERSTAND AND AGREE TO THE FOLLOWING TERMS:

1. Code of Conduct: All individuals participating in Chapter meetings and events agree to be kind, treating all others in the Chapter with respect, actively participate in meetings and activities, follow directives of Chapter leaders, prioritize safety and well-being and work together to create a positive and supportive Chapter group environment.

2. Personal Care Policy: SPECIAL TOUCH MINISTRY DOES NOT provide Personal Care Support during Chapter Meetings or Events. This includes but is not limited to:

  • Eating or mouth hygiene
  • Using the toilet or hand hygiene
  • Catering to dietary needs
  • Medication management or dispensing

If personal care is needed during a Chapter meeting/event, participant needs to provide their own Caregivers or Personal Care Staff.

3. Staff Authority & Safety: Volunteer Staff are not authorized to restrain or prevent any guest from leaving a Chapter meeting. Their role is to provide support and guidance. In the event that a guest chooses to leave early, and it is indicated in the registration that contact is requested, we will attempt to contact the parent, guardian, or emergency contact.

4. Post-Meeting Responsibility: Once the Chapter meeting has concluded, Chapter staff are not responsible for monitoring the whereabouts of individual participants. Participants will NOT have a "check out" process.

5. Media Release: I permit Special Touch Ministry, Inc. to use all photographs, multi-media images, and recordings made by or obtained from any Special Touch Ministry Chapter meeting or event. Photographs and video images taken by individuals at a Special Touch function are for Special Touch Ministry, Inc. or personal use only.

6. Medical Treatment: I authorize emergency or critically necessary medical treatment, including any required procedures, to be administered by trained personnel to the participant while participating in a Special Touch Ministry Chapter Meeting or event. Permission is given to transport the individual to a medical facility to receive EMERGENCY medical treatment. I agree to assume financial responsibility for any medical treatment.

7. Privacy & Communication: I authorize the addition of the participants contact information including email address to Special Touch Ministry mailing and contact lists. I may request removal at any time. All personal information provided in this form will be kept confidential and used solely for Special Touch Ministry programs and services.

8. Accuracy & Updates: I confirm that the information provided in this participation form is correct to the best of my knowledge. I understand that in the event any information changes, I MUST complete a new form prior to Chapter participation.

⚠️ LEGAL AGREEMENT: This certification must ONLY be completed by the Participant or their legally authorized representative (Parent/Guardian).
Agreement
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Tip: use app on phone if needed