Youth Group Registration Form

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