Children/Youth Registration Form • Steele Memorial United Methodist Church

Child/Youth Registration Form

This form updates details of minors to participate in children/youth activities at Steele Memorial UMC.

Please enter child's name and details, but please put phone and email address of caregiver not the child. We will use this to send any program updates, etc. about children/youth activities.

Basic Information

First Name

Child's Legal First Name (Add preferred name below)

Last Name

Preferred Name

Date of Birth

Gender

Registering for:

Choose which children's ministry(s) your child(ren) will be participating.

Location

Youth/SWAG

Youth (SWAG) Parent permission to include my child in group Texts/Emails regarding church activities.

Mobile Number - Youth(SWAG)

Email - Youth(SWAG)

Responsible Person Information

Name (Parent/Guardian/Responsible Adult)

Mobile Number

Responsible Person Mobile Number

Tip: Mobile number of parents usually, but if under the care of a friend or other relative enter their number. It will be used to contact person during activity if an issue with child occurs.

Responsible Person Email Address

Tip: Email address of parents usually, but if under the care of a friend or relative enter their email.

Responsible Person Relationship *

Other Information

Home Address

Home City

Home State

Home Zip Code

Home Phone Number

Other Relevant Information

Tip: Please let us know anything if it will help us love your child better. (e.g. Does not like loud noises or struggles in group settings, etc.)

Medical

Medical/Dietary Information

Tip: Any information that is relative to the care of your child, especially dietary restrictions.

Emergency Medical Treatment Authorization

I authorize the leader in charge to arrange for my child to receive first aid and medical treatment as a trained first aid person may deem necessary.

I authorize the use of calling an ambulance in an emergency.

I accept responsibility for payment of all expenses associated with such treatment.

Tip: All conditions must be accepted to participate in church programs.

Media

Publishing Opt-Out

I DO NOT want photos of my child to be displayed in the church publications, e.g. website, newsletters, brochures, etc.

Tip: Occasionally we may take photos of children/youth activities to share with wider church community. Please indicate if this is something you want us to try and exclude your child from. Please understand in group photos this is harder to manage, but we will do our best.

School

Name of School

School Grade

Special Needs Child

Authorization

By typing your name and date you are authorizing your child/youth to participate in activities at Steele Memorial UMC.

Digital Signature

Date: