Glen Elm Youth Group Registration (2019-2020)

Welcome to another year of the Glen Elm Youth Group! We are so excited for the year ahead - to grow together in many ways - and we are glad to have your child/children along for the journey. Please complete the following form as a way of providing us with contact and other essential information. You will be kept informed of any special events, or changes to our regular routine, as the year unfolds. For now, thanks so much for allowing your kids to participate in Glen Elm Youth! - Jonathan Slywka

Parent/Guardian Information

Parent/Guardian 1 (first name, last name)

Parent/Guardian 2 (first name, last name)

Phone Parent 1

Phone Parent 2

This address will receive a confirmation email

Address

Youth Information

Name

Phone

Birthday DD-MM-YYYY

Health Card Number

Please indicate any health issues or food allergies that we should be aware of:

Medical Release

Please read the following carefully, and enter your name in the space provided below if you agree to the terms of this medical release. This is intended to provide a general 'permission' for the activites of our year together. Note that Jonathan will also always provide you with additional information on specific events as they approach, at which time he may also ask your permission in order for your children to participate in those events.

*As a parent and/or guardian, I, the undersigned, understand that Youth Group activities may pose risks to personal health and safety. I also acknowledge that group activities may require my child to travel off the church premises, with transport provided in the personal vehicles of Youth Group leaders. I hereby agree to release Glen Elm Church of Christ and its staff and volunteers from liability in the event of Injury. •*Furthermore, as a parent and/or guardian, I do herewith authorize treatment under the direction of any licensed physician of the minor registered above in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. I, the undersigned, also assume the responsibility for any cost connected with such treatment. •*This form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence. A copy of this authorization can be used as the original.

Parent/Guardian Name (first name, last name)

Photographs

Pictures are sometimes taken of Youth ministry activities for promotional purposes, which include, but are not limited to, in-house presentations, church websites, brochures, and newsletters. Children's names/information are never used without specific permission. Please indicate below if you are allowing Glen Elm Church of Christ to use photographs of your child as stated above.

Photographs

Yes No

Description

Please fill out this form and click submit.

Glen Elm Youth Group Registration (2019-2020)

Description

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