Southminster Youth Registration 2024-2025

SOUTHMINSTER PRESBYTERIAN CHURCH

2024-25 YOUTH GROUP MINISTRY & EVENTS REGISTRATION
Kari Sealund, Youth Ministry Director 916 East Central Road, Arlington Heights, IL 60005 847-392-1060 email: kari@spcah.org www.spcah.org

All youth grades (Sixth Grade - Twelfth Grade) must have a parent complete this form! All parents must register each September, every year. Thank you!
Youth Name

First NameLast Name
Grade in 2024-25
Allergies
Date of Birth

MonthDayYear
Date
Youth Name 2

First NameLast Name
Grade in 2024-25
Allergies
Date of Birth

MonthDayYear
Date
Youth Name 3

First NameLast Name
Grade in 2024-25
Allergies/Other
Date of Birth

MonthDayYear
Date
Youth Name 4

First NameLast Name
Grade in 2024-25
Allergies/Other
Date of Birth

MonthDayYear
Date
Parent/Guardian

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
In Case of Emergency Contact:

First NameLast Name
Home Phone
Emergency Contact Phone
Cell Phone
MEDICAL EMERGENCY- If, in the judgment of the adult sponsors, medical treatment should become necessary, it is understood that every possible effort would be made to contact the parent or guardian immediately. However, there is always the possibility that we might not be able to reach you, particularly, for instance, if you plan to be away from home during this activity.

By signing below, you, the parent/guardian, give permission for the adults in charge of the event to obtain emergency medical treatment, only in the event that you cannot be reached for prior consent and agree to bear the financial responsibility for the treatment.

I GIVE PERMISSION FOR EMERGENCY MEDICAL TREATMENT IN CASE IT IS NECESSARY AND I CANNOT BE REACHED.

* Please attach a copy of your insurance card or provide a copy to the youth ministry later.
Signature

Clear
NAME OF FAMILY DOCTOR
DOCTOR'S PHONE NUMBER
MEDICAL COVERAGE* (company & policy #)
Please upload a copy of your medical card - front and back

Cancelof
SPC Youth 2024-2025 Activities

Parents: Below is a list of locations. Some activities have more risk than others, so discuss with your teen or child the limits you want them to respect. Information about specific events will be provided in a timely manner to all parents and youth.

As a parent or guardian of the above young person, I give my consent for him/her to participate in the specified list of Youth activities sponsored by Southminster Presbyterian Church and to travel to and from the event accompanied by adult leaders. In consideration of the benefits to be derived, and in view of the fact that the Southminster Youth Group is a religious group, membership in which is voluntary, and having confidence that every precaution will be taken to assure the safety and wellbeing of my child on the activities named below, I agree to his/her participation and waive all claims against the leaders of this trip and representatives of Southminster Presbyterian Church.

Transportation is in personal vehicles driven by youth leaders and/or parents Examples of possible outings might include the following:

Mountain View Adventure Center 510 E. Algonquin Road, Des Plaines, IL 60016 (847)391-5733

Bowlero 824 E Rand Road, Mount Prospect, IL 60056 (847) 392-0550

Mastermind Escape Games 1015 E. State Parkway Schaumburg, IL 60173 (847) 453-4348

Forest Preserves for Hiking, Biking or Canoeing Example: Busse Woods (Elk Grove Village)

Any restaurant within the Northwest Suburbs of Chicago, or in the near vicinity of any of the above establishments Examples: IHOP, Armand's Pizza, Panera Bread, Culvers
Date

MonthDayYear
Date
Signed

Clear
Parental Comments or Concerns
PHOTO & MEDIA POLICY - We will be taking photos of Youth Sunday School classes and events for our website and Church social media. Individual participants will NOT be identified in any photos. We will also be Livestreaming our Sunday Worship Services.

I grant permission for my child to be included in pictures and media connected with Southminster Presbyterian Church.
Parent/Guardiar Signature

Clear
Date

MonthDayYear
Date
- SPC Youth 2024-2025 Communication Preferences
As a parent of a youth, please indicate your preferred way of communication regarding Youth events.
Preferred Communication

EmailText
Parent Name
Parent Email
example@example.com
Parent Cell
Please enter a valid phone number.
Preferred Communication

EmailText
Parent Name
Parent Email
example@example.com
Parent Cell
Please enter a valid phone number.
Do you give permission for youth staff to send communication regarding Youth events directly (without copying you) to your youth?

YesNo
Youth Name 1
Preferred Communication

EmailText
Youth Email
example@example.com
Youth Cell
Please enter a valid phone number.
Youth Name 2
Preferred Communication

EmailText
Youth Email
example@example.com
Youth Cell
Please enter a valid phone number.
Youth 3 Name
Preferred Communication

EmailText
Youth Email
example@example.com
Youth Cell
Please enter a valid phone number.
Youth 4 Name
Preferred Communication

EmailText
Youth Email
example@example.com
Youth Cell
Please enter a valid phone number.
Electronic Communication with Youth participant Policy

All communication between staff and youths must be transparent. The following are examples of appropriate and inappropriate electronic communication:

Appropriate Electronic Communication:

Directly sending and replying to emails and text messages from youths with parent's permission indicated on registration form for each school year. If parent has not given permission to do so, staff will always copy parent

Communicating through "organization group pages" on Facebook or other approved forums.

Inappropriate Electronic Communication

Harsh, coercive, threatening, intimidating, shaming, derogatory, demeaning or humiliating comments.

Sexually oriented conversations.

Posting inappropriate comments on pictures.

Southminster Contact for all items above:

Kari Sealund, Youth Ministry Director

Church Phone: 847-392-1060 Email: kari@spcah.org

Dates of Waiver: September 1, 2024 - August 30, 2025
Should be Empty:

SOUTHMINSTER PRESBYTERIAN CHURCH