2023 - 2024 Youth Registration and Permission Slip

This is a registration form / permission slip for students in grades 6th through 12th who plan on attending Sunday School at APC and/or Crossroads. This must be filled out by a parent or guardian.

YOUTH REGISTRATION

Please indicate which program(s) your child is interested in.

Confirmation Class Sunday School Crossroads Youth Group

Student Info:

Name

Birthdate

Gender

School

Grade

Student Cell Phone

Address

Present Church Affiliation:

Parent Info:

First Parent/Guardian Name

First Parent/Guardian Email

This address will receive a confirmation email

First Parent/Guardian Cell Phone

First Parent/Guardian Address

Second Parent/Guardian Name

Second Parent/Guardian Email

Second Parent/Guardian Cell Phone

Second Parent/Guardian Address

Help us share the love of Jesus Christ with our youth by: (Check all that apply)

Shepherding or teaching our students. Serving on the Hospitality Team that hosts our meals each week. Driving for mission or fun nights once a month. Help to fund-raise our annual operating budget. Participating in special events. None of the above

Would you like to receive our monthly Purposeful Parenting resource email that includes podcasts, articles, book suggestions, conversation guides, upcoming parent events, and more?

Would you be interested in joining a small group of parents that meets every 3-4 weeks to learn together, and share the joys and struggles of parenting? Yes No

Emergency Contact Info:

This will be the 1st person we call in the case of an emergency.

Emergency Contact Name

Emergency Contact Cell

Emergency Contact Relationship to Student

Other Info:

Any other information you would like us to know about your child or family:

Any clubs/sports/groups that we can support your child in:

Please list any allergies or dietary restrictions that your child has.

Please use the following space to share with us any questions or concerns you have:

PERMISSION SLIP

Youth Activities Permissions: I [parent/guardian] hereby give permission for my child/youth [named above] to attend and participate in any Church-sponsored youth ministry activities and events during the period of September 1, 2023 – August 31, 2024, including activities off the Allentown Presbyterian Church campus (either walking or by vehicle). This permission slip covers but is not limited to Sunday School “road trips”, monthly youth group mission visits, fun events and retreats, and includes permission for my child/youth to ride in any vehicle driven by an approved and licensed adult chaperone while attending and participating in Church-sponsored activities.

Youth Activities

Agree Do Not Agree

Parent/Guardian Initials

Media Permissions: I also grant permission to the Allentown Presbyterian Church to take and publish photographs, video, voice recordings, or any other likeness of my child/youth for use in published material (including print, web-based (digital), and other media types) that may be presented in the public domain (either during or outside of Church services or Church-sponsored programs) for the purpose of promoting Church-sponsored programs, ministries, activities, or events.

Media

Agree Do Not Agree

Parent/Guardian Initials

Medical Treatment Permissions: In the event my child/youth is in need of emergency medical care, I understand that I will be contacted immediately to authorize care. If I cannot be reached, I authorize Church staff to consent to any emergency x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care, to be rendered to my child/youth on the advice of a licensed physician or the medical staff of a licensed hospital or emergency care facility. I agree to be liable and agree to pay all costs and expenses incurred in connection with such medical services rendered to my child/youth pursuant to this authorization.

Medical Treatment

Agree Do Not Agree

Parent/Guardian Initials

*By entering my name in the box below, I am providing my digital signature on this form.

Parent/Guardian Signature

Important Note to Parents:

The safety and well being of all children and youth entrusted to the Church's care is of paramount importance to the Allentown Presbyterian Church. That is why a policy has been developed to ensure the protection of our children and youth. Copies of the Allentown Presbyterian Church's Child and Youth Safety Policy are available upon request.

If you have any questions please contact Courtney Stover at courtney@allentownpresbyterian.org

2023 - 2024 Youth Registration and Permission Slip

Description

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