Rooted Youth Registration
Welcome to Rooted Youth. We can't wait to get to know you and help you draw closer to God as we spend time together each week. Every time we meet we have fun, play games, get to know each other, worship God, and learn more about God from his word. We have instituted some new rules with the pandemic and we are a safe place to learn about who Jesus. We have also been taking actions to protect ourselves from COVID-19. These are some of the rules for participating in our youth ministry.
1.) If any member of your household is not feeling well or running a fever, DO NOT ATTEND.
2.) Every participant must wash in/wash out as they enter the building
3.) Social Distancing requirements must be maintained: 6 Foot Distancing or a face mask/face shield worn.
4.) Rooted Youth is for students entering 7th - 12th Grade only
If you have any questions feel free to e-mail me at
or call me at 607 698 4484.
THIS FORM MUST BE COMPLETED BY A PARENT WHO GIVES PERMISSION FOR THIS STUDENT TO ATTEND.
Student First Name
Student Last Name
Student Phone Number
Parent Phone Number
Name one Friend who you would like in your small group. ONLY ONE (Siblings are automatically in your grouping)
Emergency Contact Name
Emergency Contact Phone Number
PARENT PERMISSION AGREEMENT
As legal guardian/parent of the student aforementioned above, I hereby give this student permission to participate in Rooted Youth. I understand the risks that are involved in meeting together and release Buena Vista Wesleyan Church, Paid Staff, and Volunteers from any liability in regards to contracting COVID-19. We promise to protect and ensure your child's safety through the previously stated requirements for attending and our own diligence in protecting the aforementioned student. Students who do not comply with direction will be sent home immediately at the discretion of the volunteers and staff of Buena Vista Wesleyan Church. By clicking submit you agree with these requirements and release this student to participate.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Houghton College.