Youth Registration Form Youth's Full Name Youth's Date of Birth Parent/Guardian Name Home Address Zip Code Home Phone Mobile Phone Email Allergies, Medical Conditions, or Special Needs Emergency Contact Name Emergency Contact Phone My child may walk to and from church on their own.My child may be picked up by the youth director or other program staff, volunteers, or peers as needed to participate in youth group activities.I confirm that my child is in good health and capable of participating in youth group activities. I agree to my child taking part in these activities. In the event of an accident, I consent to any necessary medical treatment, including treatment by medical professionals in an emergency.I give permission for photos or videos of my child to be taken for local promotion (e.g., newsletters, church events). I understand that my child will not be identified by name in these materials.
