Request edit access
Youth Registration Form for St. John's Ivyland (2022-2023)
September 11, 2022 - June 11, 2023 (2022-2023)
All youth (Grades 7 - 12) participating in activities at St. John's UMC Ivyland must complete a registration form annually.  This form can be used for any of our youth ministry activities including Sunday school, Confirmation, choirs, and general church activities. Your information will be shared confidentially with each of your child's teachers at St. John's UMC Ivyland so that you don't need to fill out the same information multiple times.

Please complete one form for each child in your family.

* Required


Sign in to Google to save your progress. Learn more
Email *
Child's First Name *
Child's Last Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Grade Level for the 2022-2023 School Year *
My child has not been confirmed yet and would like to enroll in confirmation classes for the 2022-2023 school year (see letter for details).
Clear selection
What year will your child graduate?  (Class of) *
Does your child have any existing medical condition(s)? *
Required
If you answered "Yes" above and your child has an existing medical condition(s), please identify
Does your child have any allergies? *
If you answered "Yes" above and your child has allergies, please identify
Home Address *
Full Name of Parent(s) or Guardian(s) *
Home Phone Number
Parent(s) or Guardian(s) Cell Phone Number *
Student Cell Phone Number
What is the best number to reach you in case of an emergency?
If you can't be reached, who should we call in case of emergency?  Please provide full name and best phone number to reach them if there is an emergency.
What would be important for the teachers to know about your child?  What is one thing that would help make this year the best for your child?
I give  permission for my child to participate in activities sponsored by St. John's UMC of the Eastern Pennsylvania Conference of The United Methodist Church. *
What school district are you in?
I give permission to St. John's UMC Ivyland for my child to be photographed for use within the St. John's UMC Ivyland community, including website and social media platforms. *
The following person(s) has my permission to pick up my child from a St. John's activity or event. *
My child is a licensed driver and has my permission to drive to and from a St. John's UMC  event or activity using a personal vehicle insured by me (as Parent or Guardian).  I understand that St. John's UMC will not be providing insurance coverage for this vehicle, and I release St. John's UMC from any and all liability related to this travel.  Anyone riding with my child should write a consent form which will be kept on file at St. John's UMC. *
My child has my permission to drive other individuals to and from a St. John's UMC  event or activity using a personal vehicle insured by me (as Guardian).  I understand that St. John's UMC will not be providing insurance coverage for this vehicle, and I release St. John's UMC from any and all liability related to this travel.  If yes, please identify individuals below. *
The following person(s) is allowed to ride with my child in a personal vehicle insured by me (as Guardian).
I hereby authorize event staff to obtain and give consent for medical treatment for my child for such injury or illness that may occur during any St. John's UMC sponsored event and hold the event staff and their representatives harmless in the exercise of this authority.  I give my permission as Guardian for my child to be transported in vehicles operated by the adults in whose care the minor has been entrusted while attending and participating in the events.  It is my understanding that my child will be covered by my personal medical insurance.  The event provides limited/supplemental medical payment coverage for injuries arising out of the event activities which is payable in excess of any other collectible insurance.  Payments of any medical injuries not covered by my insurance or the event limited/supplemental medical insurance will be paid by me. *
Please provide name of medical insurance carrier and group number. *
BEHAVORIAL AGREEMENT:  At St. John's UMC, we believe that all people are loved by God.  In response to God's love for us, we need to show love and respect for ourselves and others.  Our behavior should reflect this love and respect and include these qualities:  Patience, Honesty, Kindness, Generosity, Cooperation, Gratitude and Self-Control.  Should a situation arise where behavior of a my child disrupts classroom activities, my child will be removed from the situation.  Inappropriate behavior towards another individual, church property, vehicles, the property of another individual or churches we may visit during an event may result in my child being financially liable for their actions.  In the event of property damage, my child and I agree to reimburse all damages caused by my child.  Should it be necessary for my child to return home from a St. John's UMC event that takes place off premises, due to medical or disciplinary reasons, prior to the end of an event, I, the undersigned, shall assume all transportation responsibility and costs. *
VERIFICATION:  I have read all of the information on this form.  By filling in my name below, I verify that all information on this form is true and accurate *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms