2022-23 registration

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

* Indicates required field

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 *

Emergency Contacts

Name *

Phone *

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

Name and Relationship *

Phone *

Name and Relationship (2) *

Name and Relationship (3) *

Phone *

Permission to publish photos/videos of the aforementioned 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

Allergies, Medical Conditions, or Medications Taken *

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)

Parent Signature *

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

2022-23 Westminster Presbyterian ChurchYouth Registration & Consent Form

Medical Information

Parent Electronic Signature and date (please type)

2022-23 Westminster Presbyterian Church
Youth Registration & Consent Form