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Rev. Dr. Blythe Denham Kieffer
Rev. Trajan Iliff McGill
Rev. Christian Ko Choi
Rev. Gerald Boutelle
Dale T. Rogers
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Worship at Westminster
Worship Services 2021
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Photo Gallery 2021
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2020-2021 WPC Child/Youth Registration & Consent Form
Please fill out this form for each child/youth participating in the Christian Education and/or Youth programs at Westminster Presbyterian Church
Child Information
*
Indicates required field
Child/Youth Name
*
First
Last
Age
*
Grade
*
Birthdate
*
Parent/Guardian Names
*
Primary Address
*
Home Phone
*
Parent/Guardian Cell Number
*
Parent/Guardian Email
*
Parent/Guardian Cell Number
*
Parent/Guardian Email
*
Youth Cell Phone Number
*
Youth Email Address
*
Emergency Contacts
Name
*
Phone
*
Name
*
Phone
*
Children pre-K - 5th grade: Permission to leave Sunday School with a 6th grader or older sibling
*
Yes
No
Youth - Permission to leave after a program without an adult
*
Yes
No
Permission for an adult leader to drive my youth to or from an off-site activity
*
Yes
No
Permission to publish photos/videos of the aforementioned child/youth (I understand that photos/videos will only be used to enhance the communication and ministry of our congregation, such as worship, Christian Education, mission trips, youth events and other special events
*
Yes
No
Medical Information
Medical Insurance Company and Policy Number
*
Name of Insured
*
Allergies, Medical Conditions, or Medications Taken
*
Family Information
Is your child/youth baptized?
*
Yes
No
Are both parents members of WPC
*
Yes
No
If yes, date and place of baptism
*
If one parent (guardian) has another religious affiliation, please indicate
*
Parents Status
*
Married
Separated
Divorced
Other
Provide more information if Status is Other
*
Student lives withChoose One
*
Both Parents
Mother
Father
Alternates
Siblings and their class (or age)
*
AUTHORIZATION AND WAIVER:
My child has permission to participate in the Christian Education and youth programs sponsored by Westminster Presbyterian Church, and any trips and special activities sponsored by such programs. In the event of illness or accident, if I cannot be reached or if circumstances require immediate action, I authorize the church and its agents to consent to any examination, treatment or medical care for my child that is deemed advisable and provided under the supervision of medical personnel. I also release the church and its agents from responsibility in the case of illness or accident in connection with church activities. I understand that providing the Medical Information above is optional, and is for the purpose of providing Westminster with information about my child’s allergies, medical conditions and health insurance in the event of a medical emergency.
Parent Electronic Signature and date (please type)
Parent Signature
*
PARENTAL/GUARDIAN PARTICIPATION:
It takes a village! Your help and participation in our Christian Education and youth programs is essential to their existence and functioning. Not only do you demonstrate the importance of the church and its ministry to your children and youth, but they really do like to see you! Keep an eye out for how you can help volunteer with our programs.
Submit
