2016-2017 Youth Registration

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Medical Information

    Medical attention for my youth/child is covered under the following insurance policy:
    This is a required question
    This is a required question

    Permissions

    By typing my initials below, I agree that my child has permission to participate in Youth activities including field trips, on-site and off-site events. S/he has permission to be transported by an adult staff member or volunteer who complies with the PUMC driving policy. I understand that PUMC follows Safe Sanctuary guidelines. Certain events may require a separate permission form. If it becomes necessary for my child to come home for any medical or disciplinary reason, I agree to provide transportation at my own expense. I give permission for my child to receive basic first aid if necessary. If professional medical care is required, every attempt will be made to contact me using the information on file. If I cannot be reached, emergency medical treatment may be rendered at the closest available facility. If major surgery is required, agreement by two licensed physicians must be obtained. I will be responsible for any costs associated with these, or any medical treatments. I understand this form is applicable for the 2015-2016 Youth program year and that next year I will be required to complete a new form. PUMC will occasionally take photographs of youth engaged in church activities. By choosing the appropriate option, you will be either granting or denying permission for PUMC to use photographs of your child(ren) in promotional materials, including posters, brochures, the PUMC Web site and Facebook page, and other such publications.
    This is a required question
    This is a required question
    This is a required question