CHILDREN AND YOUTH REGISTRATION 2017-2018
For all NEW registrations: IF YOU HAVE NEVER REGISTERED YOUR CHILD BEFORE.

If you have registered your child before, you can use the short form. Click the link below to get to that form.
https://docs.google.com/forms/d/e/1FAIpQLSd5grIrADcVojjkKVwt12fk99CG5PLifVvqeS61SZg3KonEdA/viewform

Please register all children and youth (birth - 18 years) here.
Each child needs to be registered separately.

Family Last Name *
Your answer
Child first name *
Your answer
Child last name if different from family last name
Your answer
Date of Birth: MM/DD/YYYY *
Your answer
Male or Female *
Grade going into in the 2017 school year *
Any existing medical conditions, allergies, or special concerns. Please be specific.
Your answer
Parent or Guardian's Names *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone Number
Your answer
Email Address to receive Children/Youth Ministry News and Updates
Your answer
PARENTAL CONSENT: I give permission for my child to participate in activities sponsored by St. John’s United Methodist Church of the Eastern Pennsylvania Conference of The United Methodist Church during the 2017 - 2018 year. *
Required
I give permission for my child to be photographed for use within the St. John’s community and/or website. I understand that no personal information will be displayed with the picture. *
Required
PICK UP PERMISSION The following person(s) have my permission to pick up my child/children from a St. John’s activity or event. *
Must be over 18 years old to pick up. Please use commas to separate names, not returns.
Your answer
My son/daughter, who is at least 13 years old, has my permission to walk unescorted to the bathroom or water fountain during a St. John’s UMC activity.
PERMISSION TO DRIVE My son/daughter is a licensed driver and has my permission to drive to and from St. John’s UMC activities using a personal vehicle insured by me. I understand that St. John’s UMC will not be providing insurance coverage for this vehicle, and I release St. John’s UMC from any and all liability related to this travel. Anyone riding with my child should write a consent form which will be kept on file at St. John’s UMC.
To ensure the safety of our youth, please indicate whether or not any other individuals may potentially ride in the vehicle with your licensed son/daughter. I agree to release St. John’s UMC from any and all liability related to the claims made by other individuals in the vehicle with my son/daughter.
Names of people your child has permission to transport.
Your answer
MEDICAL TREATMENT AND LIABILITY RELEASE: I hereby authorize event staff to obtain and give consent for medical treatment for my child for such injury or illness that may occur during the St. John’s sponsored event and hold the event staff and their representatives harmless in the exercise of this authority. I give my permission for my child to be transported in vehicles operated by the adults in whose care the minor has been entrusted while attending and participating in these events. It is my understanding that my child(ren) will be covered by my personal medical insurance. The event provides limited/supplemental medical payment coverage for injuries arising out of the event activities which is payable in excess of any other collectible insurance. Payments of any medical injuries not covered by my insurance or the event limited/supplemental medical insurance will be paid by me.
Please list the best phone number to call in case of emergency.
Your answer
Medical Insurance Carrier and Group No
Your answer
PARENT AND STUDENT BEHAVIORAL AGREEMENT (For children and youth grades K-12) At St. John’s, we believe that all people are loved by God. In response to God’s love for us, we need to show love and respect for ourselves and others. Our behavior should reflect this love and respect and includes these qualities: Patience, Honesty, Kindness, Generosity, Cooperation, Gratitude and Self-Control Should a situation arise where behavior of a child / youth disrupts classroom activities, the child or youth will be removed from the situation. Inappropriate behavior towards another group member, private party, church property, vehicles, the property of persons or churches we may visit during an event may result in the student being financially liable for their actions. In the event of property damage, the student and parent agree to reimburse all damages caused by the student. Should it be necessary for the child/youth to return home from a St. John’s event that takes place off premises, due to medical or disciplinary reasons, prior to the end of an event, the undersigned shall assume all transportation responsibility and costs. Checking below implies that you have read the above and agree to abide by it.
I have read all of the information on this form. By filling in my name below I verify that all information on this form is accurate and I am in agreement.
Your answer
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