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

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

    Thank you for filling out another important form for your family. Information received is confidential and is being gathered for the purpose of supporting families in our Children's Ministry and serving child participants during sponsored activities at Southminster Presbyterian Church of Arlington Heights. Any medical information collected on this form serves to authorize our church, its staff and volunteers, to obtain medical assistance in emergencies. Questions? Contact Jill Schiltz, Director of Children's Ministry, at jill@spcah.org.
    • Information  
    • Parent's Contact Information  
    • 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. Currently, all adults working with children are fully vaccinated and we encourage indoor mask wearing for unvaccinated children over the age of 2. As the parent or legal guardian of the above-named participant, 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, 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 and 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.

    • Signature  
    • By signing and submitting this registraiton form, you understand and agree to all Southminster policies and liability information.

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