2024-2025 Southminster Child Registration Form for Children's Ministry

CHILD REGISTRATION 2024-2025: For participation at church and Faith-at-home Deliveries

Registration, Information, Authorization & Medical Consent Form for Infants-5th Graders
Dear parents,

Please fill out or update the information slots below for the 2024-25 school year. You may also fill out a paper form at church....but digital is so handy and Ms. Jill get's your information right away! :) Questions? Trouble? Contact Jill Schiltz, Director of Children's Ministry, at jill@spcah.org. Blessings!

Information
Child 1 Name*

First NameLast Name
Child Age 1*
Child 1 Date of Birth*

MonthDayYear
Child 1 Grade or Year in PK (Fall 2024)*
Child 1 Medical Concerns/ Allergies
Child 2 Name

First NameLast Name
Child Age 2
Child 2 Date of Birth

MonthDayYear
Child 2 Grade or Year in PK (Fall 2024)
Child 2 Medical Concerns/ Allergies
Child 3 Name

First NameLast Name
Child Age 3
Child 3 Date of Birth

MonthDayYear
Child 3 Grade or Year in PK (Fall 2024)
Child 3 Medical Concerns/ Allergies
Child 4 Name

First NameLast Name
Child Age 4
Child 4 Date of Birth

MonthDayYear
Child 4 Grade or Year in PK (Fall 2024)
Child 4 Medical Concerns/ Allergies
Do you have more than 4 children? Email Jill@spcah.org to submit their information.

Parent's Contact Information
Parent/Guardian (Primary Contact-Best Family Contact)*

First NameLast Name
Phone Number (Best Family Cell for Occasional Texts)*
Best Family Email
example@example.com
Parent/Guardian 2 Name (Additional Contact)

First NameLast Name
Parent/Guardian 2 Phone Number
FAMILY ADDRESS (Optional, but we like this for church home deliveries and birthday cards.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Liability Information
CONSENT FOR PARTICIPATION AND MEDICAL TREATMENT | I give permission for my child to participate in the Southminster Children's Ministry programs. I understand that Southminster Presbyterian Church of Arlington Heights (SPCAH) is hereby relieved from any liability for loss of property, damage to property, or any personal harm that may come to the participant. As the parent or legal guardian of the above-named participant, I hereby give my consent for emergency medical care prescribed by a duly licensed doctor. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.
COVID | As protocols around Covid continue to change, Southminster will create policy guided by the current CDC and Cook County Covid Safety recommendations. As the parent or legal guardian of the above-named participant(s), I agree to support Southminster's protocols as they evolve and agree to keep my family home if I have knowlege of a household member experiencing a fever or other symptoms of Covid.
PHOTOS & MEDIA | As the parent or legal guardian of the above-named participant(s), I understand that the reasonable use of photos and videos for in-house church displays, promotional brochures, newsletters, website, emails and on social media pages may be used if taken at Southminster events, classes, and even some worship activities. Southminster will never link your child's image with their name on any public forum without your permission and will get advance permission for all close-up photos used. However, in large gatherings and group shots, this may be difficult. I acknowledge that my family may be caught in the background of some photos and published media. I also acknowledge that Southminster may have areas in our sanctuary that are viewed during our livestream worship services and sitting in some areas in the sanctuary may show my family in the worship video livestream that is then posted on Youtube.
I understand and agree to the statements above.I have a concern about my child's image being used in social media. Please have the children's director call to discuss my options.

Signature
By signing and submitting this registraiton form, you understand and agree to all Southminster policies and liability information.
Parent/Guardian Signature*

First NameLast Name
Today's Date*

MonthDayYear
Date
Congratulations! You made it through another family form! Comments or questions? Write them here or email Jill Schiltz, Children's Director at jill@spcah.org:
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CHILD REGISTRATION 2024-2025: For participation at church and Faith-at-home Deliveries

Dear parents,