Manhattan CRC Youth Ministries Registration Form
GEMS Girls Club || Cadets Boys Club|| Junior High Youth Group || High School Youth Group
Child's Name *
Your answer
Gender
Which program(s) does your child participate in? (check all the apply) *
Required
Current Grade *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Parent(s) or Guardian(s) Name(s): *
Your answer
Address (include City & Zip Code) *
Your answer
Cell Phone (include name and phone number) *
Your answer
Home Phone
Your answer
Email Address *
Your answer
Does you child have a cell phone? *
Would you like to allow leaders to contact your child directly regarding changes or reminders? *
If so, what is your child's phone number?
Your answer
In case of emergency provide a second emergency contact (Name & Phone Number) *
Your answer
What is your preferred method of communication? *
Family Doctor
Your answer
Doctor's Phone Number
Your answer
Insurance Provider
Your answer
Policy #
Your answer
Does your child have any of the following? (check all that apply)
If you checked any of the boxes above please give details
Your answer
In case of medical emergency, I hereby give permission to the attending leader to seek medical attention as needed for the child named above. It is understood that all effort will be made to contact the parent/guardian first. *
I do hereby give child permission to attend and participate in the various activities, associated activities and functions performed by the MCRC youth ministries. At times, this will require travel to/from activities with a leader. I hereby give my child permission to travel in a vehicle with an adult leader. *
I also understand that in case of an accident or injury, etc. to my/our child, the MCRC GEMS, Cadets and youth groups, the GEMS/Cadets Organizations, Manhattan Christian Reformed Church, Bethel Christian Reformed Church, and the counselors or leaders will not be held liable. *
Manhattan CRC has a no cell phone/electronics policy while participating in youth activities. If your child brings an electronic of any kind to class or activity they will be asked to place it in a basket and it will be returned to them at the end of the meeting. Do you agree to this policy? *
Release of Photographs and Videos
Confidentiality of information is of utmost importance to Manhattan Christian Reformed Church which offers and supports the MCRC GEMS, CADETS and youth ministries. At times, photographs and videos are used to promote MCRC's programs in the media, at displays or on the church's website. Names will not be used, just photographs.
We request your permission to use photos or videos that may include your child without names identifying the child for these purposes. *
I also understand that this consent will remain in effect until a written request to revoke consent is received by Manhattan CRC *
Please type your FIRST and LAST name and DATE *
Your answer
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