Junior Youth Registration Form
Registration form for the 2019-2020 Junior Youth year at St. Catharines United Mennonite Church.
Quick Introduction
Junior Youth at St. Catharines United Mennonite Church is open to any youth entering into Grades 6-8. We meet every Monday, from 7:00-8:30pm, starting in September and ending in May. You are 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 Junior 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 will also print a 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 Junior Youth, please do not hesitate to be in contact. -Taya
Youth Information
Youth Name *
Your answer
Youth Birth Date *
MM
/
DD
/
YYYY
Youth Age *
Grade That Youth is Entering in September *
Youth Email Address (If Applicable)
Your answer
Youth Phone Number (If Applicable)
Your answer
Youth Allergies (If Applicable)
Your answer
Parent/Guardian Information
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Alternate Phone Number (If Applicable)
Your answer
Parent/Guardian Email Address *
Your answer
Parent/Guardian Address *
Your answer
Emergency Contact Information
Alternate Emergency Contact Name *
Your answer
Relation of Emergency Contact to Youth *
Your answer
Phone number of Alternate Emergency Contact *
Your answer
Permissions
I'd like to volunteer for snack duty (a schedule will be emailed and reminders will be sent throughout the year) *
I give permission for my child to leave church property for occasional 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 promotional purposes (bulletin board, slide show, church website, 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 Junior 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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