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Senior Youth Registration Form
Registration form for the 2019-2020 Senior Youth year at St. Catharines United Mennonite Church.
Quick Introduction
Senior Youth at St. Catharines United Mennonite Church is open to any youth entering into grades 9-12. We meet every Friday, from 7:00-9:30pm, starting in September and ending in May. You are absolutely more than welcome and encouraged to invite any of your friends at any time throughout the year to join us for games, events, snacks and times of sharing. They don't have to worry about registering before they come out. That said, we do require that anyone who does decide to participate in Senior Youth on a regular, ongoing basis to fill out this form. It is very important for us to have this information and these permissions on hand, so I appreciate your patience as you complete it. Once submitted, I applications will be printed hard copy, which I will have you sign and I will keep on file. If anyone has any questions regarding this, or anything else relating to Senior Youth, please do not hesitate to be in contact - Taya.
Youth Information
Youth Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Grade Entering in September *
Youth Email Address (If Applicable)
Your answer
Youth Phone Number (If Applicable)
Your answer
Youth Allergies (If Any)
Your answer
Parent/Guardian Information
Parent/Guardian Name(s) *
Your answer
Phone Number *
Your answer
Cell/Alternate Phone Number (If Applicable)
Your answer
Address *
Your answer
Alternate Emergency Contact Information
Name(s) *
Your answer
Phone Number *
Your answer
Relationship to Youth *
Your answer
Permissions
I give permission for my child to leave church property for occasional, off-site group activities *
I give permission for my child to be transported in a vehicle driven by an adult (18+) *
I give permission for pictures/videos to be taken of my child and to be used for church promotional purposes (bulletin board, slide show, website, newsletter, etc.) *
I would like to receive weekly email updates about youth discussions and events *
Questions, Concerns or Suggestions
Your answer
Parent/Guardian Signature
To be completed and collected in person at the start of the Senior Youth program year.
Please Note
While every effort is made to ensure the safety of all, accidents and loss of property may occur. By enrolling your child in our program, you agree that you will not bring any claim personally against the St. Catharines United Mennonite Church or its staff/volunteers, and that they will not be held liable for any injury or loss of property. *
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