West River Youth Group Registration 2021
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I want to register my child for... *
Required
Child's name *
Child's date of birth *
MM
/
DD
/
YYYY
Current Age *
Current School *
Current Grade
Parents/Guardians *
(Names and relationship to child)
Home Phone
Mobile Phone
Email Address
Home Address *
Allergies
(if applicable)
Dietary Considerations
(if applicable)
Other Health Concerns
(if applicable)
Emergency Contact Name *
*Please list an individual other than above
Emergency Contact Relationship to youth or child *
Emergency Contact Phone Number *
Any siblings also attending Sunday School and/or Youth Group?
(if applicable)
Is there any other information we should know?
Photo Release *
I understand that my child/ I may be photographed or recorded on video during the course of Sunday School/ Youth Group or general West River United Church activities. I provide consent for their/ my image to be used in print, electronic, or video form for display within the church, and/or the church's website and social media pages.
Are you willing to be contacted to help out with any of the following? (check any that apply)
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This form was created inside of West River United Church.