2020-2021 Christ UMC Youth Ministries Registration Form
This registration is effective September 1, 2020 through August 31, 2021. All children (seventh through twelfth grade) participating in activities at CUMC must have a current registration form on file. Classes are led by Pastor Eric Chelton and are currently being held ONLINE. Contact Pastor Eric at eric.chelton@cumclansdale, or you can contact the church office at (215) 855-1643 or secretary@cumclansdale.org.
Contact Information
Youth's Full Name *
Youth's Date of Birth *
Youth's Sex *
Address *
Home Phone *
Youth's Cell Phone and Email *
Mother/Guardian (Name, Cell Number, Email) *
Father/Guardian (Name, Cell Number, Email) *
If parent(s)/guardian(s) can not be reached, please list an alternate contact. Please provide their name, phone number, and relationship to youth. *
Medical Information
Youth's Allergies *
Youth's Medical Conditions and/or Limitations *
Youth's Medications/dosage/time. (Please note that youth will be responsible for their own routine medications unless prior arrangements are made with adult leaders.) *
Youth's Physician's Name and Phone Number *
Medical Insurance Provider and Policy Number *
Dentist's Name and Phone Number *
Dental Insurance Provider and Policy Number *
Student Information
Youth's Grade *
Youth's School *
Does your child play an instrument or have special talents? If so, please list/describe:
Is there any information you would like to share about your child that will enhance their participation and experience in the Youth Ministry Program (Sunday School, Youth Group, Youth Music, etc.)?
Drop Off/Pick Up and Transportation Information
Youth are not to arrive/be dropped off at a Youth Ministry classroom or activity until at least two Safe Sanctuary Adults are present onsite. After Youth Ministry classes, activities, or events, Youth, who are not transporting themselves, will need to be picked up by an adult or fellow Youth that has been pre-approved by their Parent/Guardian. By entering your name below, you agree to make a plan with your youth about transportation/pick-up from all Christ United Methodist Church Youth Ministry classes, activities, and events and allow Christ United Methodist Church Staff and Volunteers to release your Youth. If you do not agree to this, please discuss your Youth's pick-up/transportation with Pastor Chelton.
Parent/Guardian's Name
Release Information
Do you give permission to Christ UMC to take photographs and video of your child for church publications, website, and social media? *
In the event of an emergency, I give the Youth Group leaders permission to secure any medical or dental treatment deemed necessary for my child from a licensed provider. I expect to be contacted as soon as possible. I agree not to hold Christ United Methodist Church, its staff or volunteers liable for any damages, losses, diseases, or injuries. (Please type your name here to indicate that you have read, understand and agree to the above statement. If there is more than one parent or legal guardian, please have each type their name.) *
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