Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Relation to Child(ren)/Youth
*
Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Relation to Child(ren)/Youth
*
Would you like for the person listed above to receive communications regarding upcoming children/youth events?
*
Yes, I would like for this contact to receive information regarding upcoming events.
No, please only send information regarding upcoming events to the primary contact.
Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Relation to Child(ren)/Youth
*
Children/Youth Information
*
Please list each child's name, preferred name, date of birth, & the grade they will be in for the 2023-2024 school year.
Allergies, Dietary Restrictions, & Accommodations
*
Please list any allergies, dietary restrictions, and accommodations needed along with the child/youth's name. If none, please write "N/A"
Please indicate what activities/ministries your child(ren) may participate in this program year.
*
Check all that apply
Permission & Release Agreement
*
Checking these boxes allows your children & youth to participate in programs, events, and ministries this year.
Insurance Provider Name
*
Insurance Policy Number
*
Insurance Policy Holder Name
*
Volunteer Interest
*
Please select all that apply.
Please list any additional comments or questions you have regarding our children & youth programs this year. If there is any additional information that you would like to include to help us best support your children/youth, please put that here as well.
