2019-2020 Registration for ALL Children & Youth
Please complete this form for each of your children infant through high school senior.
Name of Child/Youth *
Date of Birth *
Address *
Child/Youth phone number
Child/Youth email
What is the child's/youth's preferred pronoun *
Church Grade for 2019-2020 *
School Name *
Parent/Guardian 1 Name *
Parent/Guardian 1 Email *
Parent/Guardian 1 Phone Number *
Parent/Guardian 2 Name
Parent/Guardian 2 Email
Parent/Guardian 2 Phone Number
Other Parent/Guardian Information (Name & Contact)
Does your child have any medical or behavioral concerns we should be aware of? *
If yes to the above question please state the medical or behavioral concern and what measures we need to take. If answer above is No, state N/A. *
I give my child/youth permission to travel with adult leaders/approved drivers by walking or riding in the church van or leader vehicles to approved destinations for single day events. *
My child's/youth's image can be used on church bulletin boards, the large TV screens in sanctuary before or during worship, church website, social media, and the church directory. *
Emergency Contact Name *
Emergency Contact Phone Number *
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