Unified Children & Youth Registration Form

Children and Youth Unified Registration Form

Please fill out one form per child.

Use this form to register your child for one or more of the following formation oportunities at Saint Georges:

• Sunday School
• Choirs for Children and Youth	• POLO (Parents of Little Ones)
• Acolyte & Lector	• EYC
• Confirmation	• Service Trip Interest

Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Child's Email (if they have one)
example@example.com
Child's Phone Number (if they have one)
Please enter a valid phone number.Format: (000) 000-0000.
Child's Rising Grade (2026-2027 School Year)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name 1

First NameLast Name
Parent/Guardian Email 1
example@example.com
Parent/Guardian Cell Phone Number 1
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Name 2

First NameLast Name
Parent/Gaurdian Email 2
example@example.com
Parent/Guardian Cell Phone Number 2
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Medical Facility
Name of Physician/Pediatrician

First NameLast Name
Dr. Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any Allergies or Medical Conditions?
Please give details

Is there anything about your child you would like us to know that will have them have a successful experience in these activities?
I, undersigned, agree with the following statements:

Should a medical emergency arise during my child's participation in a St. George's-sponsored activity, I understand that reasonable efforts will be made to contact me or my designated emergency contact at the phone numbers listed above. If it is believed that my child's life or health could be adversely affected by the delay of that attempt to contact me or my designated emergency contact, I consent to emergency medical treatment for my child in my absence. This authorization extends to my child's participation in any activity sponsored by Saint George's Church, Arlington, VA.
Date

MonthDayYear
Signature
Should be Empty:

Children and Youth Unified Registration Form