Youth Group 2024-2025 Form

Youth Group Registration Form

2024-2025
Youth Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Date
Gender
Grade
School
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Youth Phone Number (if applicable)
Please enter a valid phone number.
Youth Email (if applicable)
example@example.com
Can we email and text the youth at the above contact info via the church management software (i.e. about youth programs, events)?

YesNo
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.
Can we email and text the parent/guardian at the above contact info via the church management software, Breeze (i.e. about youth programs, events?)

YesNo
Emergency Contact

First NameLast Name
Relationship to Youth
Emergency Contact Phone Number
Please enter a valid phone number.
Health
Insurance Company
Policy Number
Group Number
Family Doctor/Medical Group Name
Please list any allergies, behavioral concerns or medical information you feel necessary to share with us:
In the event that my child requires medical attention and I cannot be reached immediately, I give Tuckahoe Presbyterian Church staff, volunteers, teachers or youth directors to seek and authorize medical treatment.
Electronic Signature of Parent/Guardian

Clear
Today's Date

MonthDayYear
Date
Video/Photo Release
Unless I have indicated otherwise below, I understand that pictures, video, recordings, and/or other audio recordings of my child may be displayed in brochures, newsletters, video productions and/or other electronic media designed for the communication purposes of Tuckahoe Presbyterian Church. I understand that my child will not be identified by name without my express written permission.
Type a question

I do not want any video or audio or pictures of my child displayed on the church property or in the brochures or newsletters, video productions or other electronic media designed for the internal communication purposes of Tuckahoe Presbyterian Church.
Electronic Signature of Parent/Guardian

Clear
Today's Date

MonthDayYear
Date
Permission for Participation & Liability Release
My child has my permission as his/her/their parent or legal guardian to participate in any and all events and activities sponsored by Tuckahoe Presbyterian Church during the 2023/2024 school year.

I acknowledge that by paritcipating in church-sponsored events, my child may be involved in activities both on and off church property, during both day and evening hours. I further acknowledge that by pariticipating in church-sponsored events, my child may be involved in recreation and sporting activities.

In recognition of these risks and realities, I agree on behalf of myself and my child to release, waive and disclaim any and all liabilities of or claims against Tuckahoe Presbyterian Church.

I further idemnify Tuckahoe Presbyterian Church for any and all damage or injury my child may cause to others as a result of his/her/their participation in church-sponsored events. I further understand that it is my responsibility to keep current the information contained on all recrod held in the church office including, but not limited to, my address, phone, emergency contact and medical insurance information.
Parent/Guardian Signature

Clear
Today's Date

MonthDayYear
Date
Covenant Youth Agreement
As a youth group member of Tuckahoe Presbyterian Church, I agree to the following:
- I agree to treat others in a Christ-like manner. To be open-minded to the ideas and opinions of each person while being respectful of others and myself.
- I agree to behave in a way that honors God at all times, understanding that my behavior and manner of speaking reflects on the entire youth group and myself.
- I agree to abide by the guidelines of all retreat centers, off-site events, and church events. To respectfully take care of property and follow requests of the adult leaders. To understand it may be my responsibility to pay or repair any damage that I may do to said property.
- I will abide by the lights out rules on overnight events, remain in the assigned sleeping areas, and be respectful of others sharing these spaces.
- I understand that no youth will be allowed to leave an event or function facility alone, and must be accompanied by an adult when away from an activity.
- I will follow the Specific Rules of: No Smoking, No Drinking Alcohol, No Illegal Substances, No Sexual Misconduct, and understand that if there is a strong suspicion of such behavior, I will be required to call my parents, and it will be their responsibility to come or make arrangements to pick me up from the activity. Consequences of such behavior will then be decided by a subsequent meeting with parents, youth and church leadership.
- I will actively participate in scheduled events and group sessions of the youth group. I will come with an open mind and heart, and not block others from their participation in youth group and their relationship with Christ.
- Youth and leaders agree to keep in confidence sensitive subjects discussed, except when an individual is in danger of hurting themselves or those around them.
I understand that it is my responsibility to uphold the covenant, and it has been put in place to bring me closer to God. If I break any part of this covenant, I may be sent home at the parent’s expense and responsibility, and will not be able to attend future events until a resolution has been reached.
Youth Signature

Clear
Today's Date

MonthDayYear
Date
Parent/Guardian Acknowledgment:

I have read the Youth Group Covenant and understand that if my child breaks the covenant and a decision is made to send them home, it will be my responsibility to come and pick them up or make arrangements to get them home.
Parent/Guardian Signature

Clear
Today's Date

MonthDayYear
Date
Should be Empty:

Youth Group Registration Form

Health

Video/Photo Release

Permission for Participation & Liability Release

Covenant Youth Agreement