RETURNING MEMBER APPLICATION

Greetings! GLOSS is delighted and thankful to have captured your interest!!

GLOSS is delighted and thankful to have captured your interest for the 20-2021 year!!

Please complete the returning member application form and submit renewal fee of $50 via a method below:

· Online: https://www.?????

· Check: Payable to GLOSS - PO 870762, Stone Mountain, GA 30087

· CashApp: $GLOSSsis

If you have questions, please contact our Membership Director, Monique Tatum at GLOSSmembership@gmail.com.

Which local GLOSS Chapter will you be joining?

APPLICANT'S CONTACT INFORMATION

Name

First Name

Last Name

Mobile Number

(###)

###

####

Home Phone

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County

ABOUT THE APPLICANT

Age

Date of Birth

T-Shirt Size

School/College

Grade/Year College

Place of Employment / Service

Place of Worship/Church

Are you a part of other activities/clubs/organizations? If yes, please share.

Is the applicant willing to accept only God's best for her life?

Is the applicant willing to obey Biblical truths?

APPLICANT'S PARENT OR LEGAL GUARDIAN INFORMATION

Mother's Full Name

First Name

Last Name

Mother's Email

Mother's Contact Number

(###)

###

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Father's Full Name

First Name

Last Name

Father's Email

Father's Contact Number

EMERGENCY CONTACT

Name

First Name

Last Name

Relationship

Email Address

Phone Number

(###)

###

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MEDICAL AUTHORIZATION

List any allergy concerns

List any health concerns

Medical Insurance

ID #

Physician's Name

Physician's Phone Number

(###)

###

####

If give my permission for my child to receive medical treatment if I cannot be reached. A parental signature is required for program participants under 18 years old.

Parent's Signature

Date

YYYY

PHOTO RELEASE WAIVER

Authorization and Release By signing this form, I permit Gods Ladies Of Significance & Service (GLOSS) to photograph my image, likeness, or depiction and/or that of my minor children (if applicable). I grant permission to GLOSS to edit, crop or retouch such photographs and waive any right to inspect the final photographs. I hereby consent to and permit photographs of me and/or those of my minor children to be used by GLOSS for any purpose, including educational and promotional purposes and in any medium, include print and electronic. I understand that GLOSS may use such photographs with or without associating names thereto. I further waive any claim for compensation of any kind for GLOSS's use or publication of photographs of me and/or those of my minor children (if applicable). I hereby fully discharge and release GLOSS from any claim for damages of any kind (including but not limited to, invasion of privacy, defamation, false light or misappropriate of name, likeness or image) arising out of the use or publication of photographs of me. I agree to have my image taken through use of still and/or video photography. My images may be used by GLOSS to promote the organization. They may use my image at their discretion in their efforts to advance the mission of GLOSS. GLOSS also reserves the right to not use any images. I have read and fully understand the above.

Print Name

Signature

Date

YYYY

PERMISSION

I declare that the information provided on this form and the GLOSS Membership Application is accurate and completed to the best of my knowledge. I understand that false information may cause my application to be rejected.

Parent's Signature

Date 2

YYYY

Applicant's Signature

Date 3

YYYY