2023-2024 Youth Ministry Registration
Student 1
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Grade
My student will be participating in this group for 2023-2024:
Rite-13 (6th-7th grade)
J2A (8th-9th grade)
YAC/Confirmation Class/Seniors (10th-12th 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 2023-2024:
Rite-13 (6th-7th grade)
J2A (8th-9th grade)
YAC/Confirmation Class/Seniors (10th-12th 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 2023-2024:
Rite-13 (6th-7th grade)
J2A (8th-9th grade)
YAC/Confirmation Class/Seniors (10th-12th 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 including, but not limited to, travel in automobiles, retreats, and outreach activities. 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
Should be Empty: