Westminster Presbyterian Church
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      • Rev. Dr. Blythe Denham Kieffer
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      • Rev. Gerald Boutelle
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    2022-23 Westminster Presbyterian Church
    Youth Registration & Consent Form

    Please fill out this form for each youth participating in the Youth programs at Westminster Presbyterian Church
    Youth Information

    Emergency Contacts
    Name and Phone number of people authorized to pick up my child.

    Medical Information

    AUTHORIZATION AND WAIVER:
    My youth has permission to participate in the 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)

    PARENTAL/GUARDIAN PARTICIPATION:
    It takes a village! Your help and participation in the youth programs is essential to their existence and functioning. Not only do you demonstrate the importance of the church and its ministry to your youth, but they really do like to see you! Keep an eye out for how you can help volunteer with our programs.
Submit
Worship Times 
Sunday Service at 10:00 a.m. in Sanctuary and Streamed Online
Child Care Available during Service

Sunday School at 10:15 a.m.
Westminster Quick Links
Westminster Calendar
Youth Group Activities

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Join us:
Westminster Presbyterian Church
533 S. Walnut Street
Springfield, Illinois 62704
 217-522-4415