2025-2026 Youth Ministry Participation Form

HCC Youth Ministry Registration Form

Please fill out one form for each student
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
2025-2026 Grade in School*
Student Preferred Pronouns
Student Cell Phone Number
Student email address
example@example.com
Student Allergies *
Please Indicate if SEVERE
Parent/Guardian/Adult Name*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian/Adult E-mail*
example@example.com
Parent/Guardian/Adult Cell Number*
If applicable, please include information (cell phone, email, addresses) for additional Parent/Guardian/Adults (and indicate which Parent/Guardian/Adult's information is listed above).
The Haslett Community Church Youth Ministry Program is made up of families from diverse faith backgrounds. To better help us understand the theological make-up of our group, please share if your family has a connection to a faith community:*

Haslett Community ChurchNew Hope ChurchSt. Luke's Lutheran ChurchUniversity Lutheran Churcha local Catholic ParishTrinity ChurchOur family is not connected to a churchThe CommonsOther
Permission to Participate:I/we give my/our permission for my/our student to participate in Haslett Community Church’s Youth Ministry activities for the 2025-2026 school year.*
Parent/Guardian/Adult Initials
I/we acknowledge that risk is inherent in participation in any activity. I/we hereby waive and release Haslett Community Church, the Rev. Erin Heisler and any adult volunteer(s)from any liability whatsoever resulting from, or happening during the duration of my child(ren)s participation in Haslett Community Church’s youth ministryactivities. By signing this release and waiver, I understand that I am giving up (waiving and releasing) any right I may have to sue or to make any subsequent claim against Haslett Community Church, its pastors, employees and volunteers.*
Parent/Guardian/Adult Inititals
I/we give permission for my/our student to participate in events both at Haslett Community Church as well as off-site with the understanding that my/our student will be driven by adults who are over the age of 21.*
Parent/Guardian/Adult Initial
Do you give permission for your student to be photographed while participating with Haslett Community Church's Youth Ministry Program, with the understanding that photographs might be printed and posted within Haslett Community Church, or shared on church, staff or volunteers' social media?*

YESNO
Parent/Guardian/Adult Signature*
First & Last Name
Should be Empty:

HCC Youth Ministry Registration Form