2023 Club 3:16 & Faith Journey Youth Registration Form

Club 3:16 & Youth Ministries

2023-2024 Registration Form

Kids Club 3:16 3:30-6:00pm Wednesday

Youth Groups 6:00-8pm Wednesday

Location: Faith Journey - 108 Burnett St, Spencer, WI 54479

johnsset@yahoo.com

715-615-9309

How many kids would you like to register?*

Student1 Information

Student1 Name*

First NameLast Name

Birthday

MonthDayYear

Grade Level

List any allergy, medication, attendance, or pickup information that we should be aware of.

Student2 Information

Student2 Name

First NameLast Name

Birthday

MonthDayYear

Grade Level

List any allergy, medication, attendance, or pickup information that we should be aware of.

Student3 Information

Student3 Name

First NameLast Name

Birthday

MonthDayYear

Grade Level

List any allergy, medication, attendance, or pickup information that we should be aware of.

Student4Information

Student4 Name

First NameLast Name

Birthday

MonthDayYear

Grade Level

List any allergy, medication, attendance, or pickup information that we should be aware of.

Student5 Information

Student5 Name

First NameLast Name

Birthday

MonthDayYear

Grade Level

List any allergies, medication, attendance, or pickup information that we should be aware of.

Guardian Information

Parent/Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Cell Phone*

Area CodePhone Number

Other Phone

Area CodePhone Number

E-mail*

Guardian#2 Information - optional

Parent/Guardian #2 Name

First NameLast Name

Phone

Area CodePhone Number

E-mail

example@example.com

Emergency Contact if you are not available

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Health Insurance Information - optional

Would you like to provide your family's health insurance information?

YesNo, just contact me if its ever needed

Insurance Carrier

Name of Policy Holder

Subscriber ID or Group Number

Card Number / Card Date

Transportation

For those attending Spencer Public Schools, a School Bus can transport kids to Club 3:16 on Wednesdays after school. It is your responsibility to remind them to catch the correct bus on Wednesdays. Check the box below if your child(ren) plans to ride the bus from Spencer School to the church:

Spencer School Bus

Yes, my child(ren) may be dropped off at the corner of LaSalle and Burnett St on Wednesday after school. While Spencer Public Schools, Burnett Transit, and Faith Journey strive to coordinate safe and reliable transportation, I understand that it is ultimately my responsibility that my child(ren) ride the correct bus on Wednesdays.

If transportation to or from any of our Club 3:16 and youth ministries would be helpful, please indicate that below. Don't be shy! You might be suprised who can car pool or what might work out. Its very common for the youth group to be dropped off at night as our ending time can be difficult to predict.

If your student(s) need transportation to or from any of our ministries, please give any details below:

Adventures & Field Trips

Whether its walking to the park or going on a hayride, off-site adventures and field trips will be an integral part of the Club 3:16 and Youth Group ministries this year. By completing this signup form, you are agreeing for them to take part in our regular adventures. We will try to inform you of the upcoming adventures:

What's your favorite way to know about the upcoming adventure?

Parental Permission and Release of Liability

I herby give permission for my child(ren) to attend Club 3:16 and/or all the Faith Journey Youth Ministries. I understand that the safety and care of my child(ren) will be the highest priority, but I agree to waive the right to pursue any claim against Faith Journey, its staff, volunteers, those providing transportation, and other families involved in the Club 3:16/Faith Journey ministries. If absolutely necessary, I give permission for medical treatment to be arranged and/or administered until I can be contacted in the event of an accident or illness. I also give permission for my child(ren) to participate in the off-site adventures and field trips, and I give permission for photos to be used for publicity purposes.

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

Signature*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at johnsset@yahoo.com