Youth / Child Information Form 2024

Child/ Youth Registration Form

Child's Name

DOB

Address

City

State

Zip

Food Allergies

Information that would be for a helpful for us to know about your child

School Attending

Current Grade

Parent Information:

Fathers Name

Address if different than child's address

Phone Number

Fathers Email

example@example.com

Mothers Name

Address if different from child's address:

Phone Number

Mothers Email

example@example.com

When attending worship, where do you typically sit

Additional Emergency Contacts
People authorized to pick up your child

Name

Relationship / Phone #

Name

Relationship / Phone #

Medical Contact Information

In the event of a medical emergency, I herewith authorize treatment under the direction of any licensed physician of the above minor child. The authority is granted only after a reasonable effort to reach me by phone at the number listed on the other side of this form has been made. The undersigned assumes the responsibility for any cost and releases One Community Church from any liability. This release is signed on my own free will with the sole purpose of providing medical treatment under emergency circumstances in my absence.

Family Physician Name

Family Physician Phone #

Preferred Hospital

OCC Communications shares photographs of kids and youth in various Family Ministry Programs and Events in church newsletters, websites, or other social media platforms as a means of promoting activities happening at the church. Please provide your authorization below should any of these photographs incude your child.

Please choose one:

I authorizeI do not authorize

Signature

Date