YFM Registration Form

YFM Registration Form
Child Information
Please provide the following information for each of your school-age children.*

Parent/Guardian #1 Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Mobile Number*
Please enter a valid phone number.
Does parent/guardian want to receive emails and texts regarding YFM events and general information?*

YesNo
Parent/Guardian #2 Information
Name

First NameLast Name
Email
example@example.com
Mobile Number
Please enter a valid phone number.
Does parent/guardian want to receive emails and texts regarding YFM events and general information?

YesNo
Emergency Contact

Please list the person you would like us to contact if no parent/guardian is available.
Name*

First NameLast Name
Relationship*
Mobile Number*
Please enter a valid phone number.

Agreements
Photography Release: I hereby grant the Church, Unity Worldwide Ministries, and their representatives permission to use photographs and videotaped images in which my child appears, in any manner whatsoever such as, but not limited to publication, display, advertising, slide show, etc.

I grant permission for art, written, or other work produced by my child to be used in any manner whatsoever such as, but not limited to publication, display, advertising, slide show, etc.

Agreement and Consent:
- I give my consent for Unity Fort Worth staff and Youth & Family Ministry (YFM) volunteers to be informed of the medical conditions or any special needs listed on the form to better care for my child in my absence.
- No drinks or food are allowed in the classrooms.
- I understand that at least one parent/guardian must be on site at all times. Any violation will result in the student's dismissal from YFM.
- I understand that it is my responsibility to pick up my child(ren) immediately after the church service or activity I am attending has ended. Children cannot be picked up by any adults except those listed on this form.
Parent/Guardian Signature*

Clear
Should be Empty: