3 minutes
The youth group registration form is open to all individuals between the ages of 13 and 18.
Youth Name
Age
Date of Birth
Phone Number
Email Address
Address
City
State
Country
Zipcode
School
Grade Level
Insurance Provider Name
Medical Insurance
Does the child have any allergies
Does the child have any medical conditions that we should be aware of
Parent/Guardian Information
Name:
Parent Cell No
Relationship
Payment Method
I agree to follow the guidelines, rules, and policies of the organization.If a chaperone or driver is needed, I'll do that.I allow my child to be photographed or be part of the video that will be used for marketing, promotion, and advertisements.The repeated offense of the youth may result in suspension or expulsion.Parent/Guardian registered in this form has legal custody over the child.I allow my child to ride any vehicle that is related to the group's activities provided that there's an adult on board.For medical emergencies, I allow the medical team of this organization to take care of my child.I release this organization from any and all liability from accident or injury to the child during the organization-related events
Parent/Guardian Signature
Date Signed