2023 - 2024 YOUTH MINISTRY REGISTRATION

YOUTH INFORMATION

Youth First and Last Name

Gender

Male Female

School

Birthdate

Does your child have a cell phone?

Yes No

If you are comfortable, please provide your youth's cell phone number.

Would you like leaders to contact your child directly regarding changes or reminders?

Yes No

Student Email (If they have one.)

This address will receive a confirmation email

Student is planning to participate in the following ministries.

Sunday School GEMS Cadets Junior High Youth Group High School Youth Group

PARENT (GUARDIAN) INFORMATION

Parent(s) or Guardian(s) Name(s):

Phone

This address will receive a confirmation email

Address

Optional: In what areas would you like to see your student grow this year?

EMERGENCY CONTACT & INSURANCE INFORMATION

In case of emergency provide a second emergency contact (Name & Phone Number)

Family Doctor

Doctor's Phone Number

Insurance Provider

Policy #

MEDICAL RELEASE and INFORMATION

In case of medical emergency, I hereby give permission to the attending leader to seek medical attention as needed for the child named above. It is understood that all effort will be made to contact the parent/guardian first.

Yes No

I do hereby give child permission to attend and participate in the various activities, associated activities and functions performed by the MCRC youth ministries. At times, this will require travel to/from activities with a leader. I hereby give my child permission to travel in a vehicle with an adult leader.

Yes No

I also understand that in case of an accident or injury, etc. to my/our child, the MCRC GEMS, Cadets and youth groups, the GEMS/Cadets Organizations, Manhattan Christian Reformed Church, Bethel Christian Reformed Church, and the counselors or leaders will not be held liable.

Yes No

Manhattan CRC has a no cell phone/electronics policy while participating in youth activities. If your child brings an electronic of any kind to class or activity they will be asked to place it in a basket and it will be returned to them at the end of the meeting. Do you agree to this policy?

Yes No

Allergies

Nature of limitations (if any)

PHOTOGRAPH AND VIDEO RELEASE

Confidentiality of information is of utmost importance to Manhattan Christian Reformed Church which offers and supports the MCRC GEMS, Cadets and youth ministries. At times, photographs and videos are used to promote MCRC's programs in the media, at displays or on the church's website. Names will not be used, just photographs.

We request your permission to use photos or videos that may include your child without names identifying the child for these purposes.

Yes, I give my permission for photos and videos of my child to be used for the above purposes. No, I do not give my permission for photos and videos of my child to be used for the above purposes (PLEASE NOTE: IF THIS OPTION IS SELECTED, YOUR CHILD WILL BE EXCLUDED FROM ANY GROUP PHOTOGRAPHS)

I understand that this consent will remain in effect until a written request to revoke consent is received by Manhattan CRC

Yes No

Entering your FIRST and LAST name and DATE, will constitute your signature.

Date entered/updated

This address will receive a confirmation email

2023 - 2024 YOUTH MINISTRY REGISTRATION

Description

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