2020-2021 Youth Ministry Registration
Student 1
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Grade
My student will be participating in this group for 2020-2021:
Rite-13 (7th-8th grade)
J2A (9th-10th grade)
YAC/Confirmation Class (11th-12th grade)
6th grade
School
Email
example@example.com
Student 2
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Grade
My student will be participating in this group for 2020-2021:
Rite-13 (6th-7th grade)
J2A (8th-9th grade)
YAC/Confirmation Class (10th-11th grade)
6th grade
School
Email
example@example.com
Student 3
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Grade
My student will be participating in this group for 2020-2021:
Rite-13 (6th-7th grade)
J2A (8th-9th grade)
YAC/Confirmation Class (10th-11th grade)
6th Grade
School
Email
example@example.com
Home Address
Parent/Caregiver Name 1
Parent/Caregiver Cell Phone
Parent/Caregiver Email
Parent/Caregiver Name 2
Parent/Caregiver Cell Phone
Parent/Caregiver Email
Health Concerns for any above youth listed:
Emergency Contact and Phone
Please check all of the below items to indicate that you have read each of them:
MEDIA CONSENT: I give permission to St. Martin’s-in-the-Field Episcopal Church to use photographs; video recordings; audio recordings; and/or other visual/audio reproductions in which my child/children listed above appears. I understand these materials are used to promote St. Martin’s ministries. I understand that only my child's first name will be used if he/she is referenced. My consent includes (but is not limited to) the church's website, social media accounts, and printed publications. I also understand that I may request that a specific image of my child/children be removed from a St. Martin’s publicity piece.
By signing this form, I give permission for my child/children listed above to participate in Confirmation and Youth Group activities at St. Martin’s-in-the Fields Episcopal Church, and general participation in activities sponsored by or associated with St. Martin’s Journey to Adulthood and youth program. I grant permission to St. Martin’s-in-the-Field Episcopal Church employees and/or volunteer staff to make medical decisions with respect to said minor child/children in the event of accident or injury when parental consent shall be unavailable or when circumstances require immediate medical decisions, and to administer medication when necessary.
Signature
Date
Submit
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