Centennial Youth 2017-2018 Registration
We are excited for a great year together! Please let us know your information and what groups/events you are registering your student for in the spaces below.

If you encounter any issues in filling out the form, do not hesitate to contact Pastor Leah at lchallberg@centennialumc.org

Student(s) Name(s) & grade (please list all if you have more than one):
Your answer
Returning students: has your student(s) home address changed in the past year? (New students choose N/A)
If it has changed OR if you are NEW to the Centennial Youth program, what is your new address? (For returning students write N/A)
Your answer
Returning students: have your student(s) cell phone(s) changed in the past year? (New students choose N/A)
If your student is NEW to the Centennial Youth program OR if your student(s) cell phone has changed (or they received one), please write their name and the number. (For returning students write N/A):
Your answer
Returning students: have your student(s) EMAIL address(es) changed in the past year? (New students choose N/A)
If your student(s) is NEW and/or their EMAIL(s) has changed (or they received one), please write their name and the number. (For returning students write N/A):
Your answer
New student: Please provide PARENT(s) information: Name(s), email address(es), phone number(s), home address(es). If you are a RETURNING parent, and this information has not changed, please write your name(s) and then N/A.
Your answer
Student(s) birthdate(s)
Your answer
What school district do/es your student(s) belong to?
Your answer
Do/es your student(s) have any allergies and/or special needs that Centennial UMC staff and volunteers should be aware of? If so, how can we be most helpful? If none, write N/A.
Your answer
Have you been receiving the weekly Centennial Youth e-newsletter?
May Pastor Leah have permission to contact your student(s) via phone, text, email and through any other social media platforms?
May your student(s) small group leaders have permission to contact your student(s) via phone, text, email and through any other social media accounts? (all of our leaders have been background checked and trained in Safe Sanctuaries)
Media Release: I understand that photos (film, video, digital) taken of my student(s) may be used by Centennial UMC (CUMC) for publication in the Centinel (newsletter), Sunday bulletin, interior of the church, CUMC website, and CUMC Facebook pages. Images used within the church may include the first name only. Images on the website will not include names. Other media and publications not listed above will not include names.
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