Youth & Children's Ministries 2021-2022 Registration Form

Please complete one form for each child.

We look forward to welcoming your family into our programs.

Student Information:

Student Name:

First Name Last Name

Grade:

Birth Date:

Month Day Year

Family/Household Information:

Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Household Home Phone:

Household E-mail:

(This is where we will contact you most often.)

Phone number where you can be reached during Sunday school

Area Code Phone Number

Parent/Guardian Information:

Parent/Guardian Name:

First Name Last Name

Cell Phone:

Work Phone:

Additional Parent/Guardian Name:

First Name Last Name

Cell Phone:

Work Phone:

Program Selections:

9:30 AM Programs for Children

Nursery PreK K - 5th Grade Program

Other Programs

Acolytes - 7 years and older Children's Choir - 5 - 14 years old

Parent Participation - please volunteer to help in whatever ways you can. Thanks!

I am available to help:

every week once a month on occasion

Click to edit

I would be willing to serve as an assistant in my child's classroom I have a special skill I would like to share (guitar playing, story telling, etc.)

Special Skill

Emergency Contact Information: If I cannot be reached, please contact:

Name

First Name Last Name

Phone Number

Relationship to Student

Allergies, Special Needs, Other Comments: Please list any drug or food allergies or special needs of this student:

Medical Insurance Information:

Physician's Name:

First Name Last Name

Insurance Company:

Name of Policy Holder:

Physician's Phone Number:

Insurance Phone Number:

Policy Numbers:

Authorization for Treatment and Photo Release: The student named above has my permission to participate in St. Stephen's Episcopal Church's Youth & Children's programs, events, field trips, and outings including play on bouncies, water slides, and other equipment. I waive any claim against the church and its approved leaders, teachers, staff, and volunteers. In case of medical emergency, I/we, the parent(s) or legal guardian(s) of the student, a minor, hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment, and hospital care which is deemed advisable by, and is to be rendered under, the general or special supervision of any licensed medical personnel on the staff of any licensed hospital or medical facility at my/our expense. This authorization is given in advance of any specific diagnosis, treatment, or hospital care required, but is given to provide authority and power to call paramedics, transport, and render care which is deemed advisable in the best judgment of the medical personnel. I consent to allow pictures of this child to be used on bulletin boards and in publications (such as handbooks, brochures, fliers, Chapel booklets, newsletters, web pages, Facebook, etc.) unless otherwise noted in the comments section of this form.

Person Submitting this Form:

First Name Last Name

Relationship to Student:

St. Stephen’s Episcopal Church

Youth & Children’s Ministries Policies

(Please read and review the following important guidelines and policies. Thank you.)

•Parents are asked to stay on the premises while their children are here on Sunday.

•Parents are always welcome to stay with their children and participate in our programs.

•There is no charge for any of our programs in Youth & Children’s Ministries

•This is a volunteer supported ministry. Please get involved and volunteer whenever you can. Together we make these program great.

• Parents of preschoolers are asked to stay with them the occasional Sunday at times when we have need for more adult participation.

•Parents of children who are having difficulty separating or are having any behavior problems may be asked to stay and help in the class.

• It is very important that young people bond with adults other than their parents and feel free to have open discussions. For these reasons, parents of youth members (grades 6-12) are not asked to volunteer in youth programs as often. We often need chaperones or drivers for youth events and would appreciate your volunteering to assist in this way. Thank You!

By submitting this form, you acknowledge that you have read the Youth & Children's Ministries Policies, and you give your authorization for treatment and photo release.