Yardley UMC Registration Form & COVID-19 Covenant
By filling out and submitting the form below, I hereby give my child permission to participate in the ministries of Yardley UMC.
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 I release Yardley UMC, its staff and sponsors, from responsibility and liability for an injury or illness that my child may sustain during this activity.  In the event of an emergency, I hereby authorize an adult leader of this activity, as agent for me, to consent to an x-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor's office or in a hospital.  I expect to be contacted as soon as possible.
 
By signing this form, I also give permission and waive the right to any type of compensation, for my child to be photographed or video taped at this event.  Pictures/Videos may be used for promotional or educational purposes and posted on Facebook (untagged), Instagram, the website, in youth and church newsletters.




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Child(ren)/Youth Name(s) and Date of Birth
Home Address
Home Phone
Parent(s) Names
Parent Email
Parent Cell
Youth Email
Youth Cell
Emergency Contact #1 Name/Relation to Student
Phone/Cell
Emergency Contact #2 Name, Relation to Student
Phone/Cell
Allergies
Last Tetanus Shot
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Existing Conditions, Medications, Physical Limitations, (or anything we should be aware of)
Family Physician Name & Phone
Insurance Company, Policy Number, and Name on Insurance
Youth T Shirt Size
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COVID- 19 Covenant (To be signed by Parents and Youth)
IN PERSON GATHERINGS
• All state guidelines for the pandemic are followed
• Everyone must bring a mask (two, if using paper masks)
• Masks will be worn when less than 6 feet apart
• No sharing of food or drink
• No contact games (GaGa, etc)
• Everyone must keep a distance of 6ft between one another
• Refrain from physical touch
• Attendance must be taken at every event and submitted to the office

RIDES
• Parents/Youth Drivers will transport themselves to and from activities.
• Rides will not be organized by Yardley UMC leadership.
• If there is an emergency that requires an adult to drive non household youth, all passengers and drivers must wear masks.

PERSONAL ACCOUNTABILITY
• All who feel sick in any way or demonstrate any symptoms (such as regular sneezing, coughing, aches, chills, etc.), even if believed to be merely seasonal allergies, should stay home.  
• All who come, come with the understanding that these protocols are put in place to minimize the risk, but do not eliminate all risk. Those who come assume their own risk. Those who are not comfortable with that should feel free to stay home

Yardley UMC Children & Youth Ministry COVID19 COVENANT
Our Ministries strongly believe in caring for one another.   We believe God calls us to love one another as Christ has loved us.    In that spirit, we have developed the following Covenant which we are asking all participants in Children & Youth Ministry programs and parents to reflect on and sign.  
These are the practices that are in place at all youth activities for all youth and adults.  If you and your family still feel uncomfortable with you attending certain activities at this time, we understand and support that decision.
If you have any questions or concerns, please reach out to .  
As a participant in Yardley UMC activities, in this time of global pandemic, I will show my care and concern for others by following the rules below.
I will…
• Maintain 6 feet of distance from those who are not in my household

• Wear a mask when closer than 6 feet to another person

• Not come into physical contact with others (Ex: handshakes, hugs, etc.)

By signing this covenant, you are making a commitment to follow these guidelines.
I agree to follow the guidelines.  I understand that failure to follow these guidelines will result in youth being sent home.  
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19.
I understand the risks of attending events during a pandemic and I accept sole responsibility for and injury, illness or expense that I or my child(ren) may experience.  On my behalf and on behalf of my child(ren), I covenant to hold harmless the church, it’s employees, trustees, volunteers and representatives from claims and liabilities.  


Parent or Guardian Electronic Signature
Youth Electronic Signature
Date of Signature
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