Youth Ministries Information 2025-2026

Youth Ministries Information & Permissions 2025-2026

Valid 06/2025 through 08/2026 for activities with/at First Congregational United Church of Christ (700 Poyntz Ave., Manhattan, KS 66502)
Click the arrow on the right side of each gray box to expand each section.
- Parent/Guardian #1 name*
  
  First NameLast Name
- Parent/Guardian #1 e-mail*
  example@example.com
- Parent/Guardian #1 phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- We primarily use a GroupMe text group for communicating with caregivers about upcoming youth events. Do you want to be a part of the GroupMe? We'll use the phone number you shared above.
- Parent/Guardian #1 Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/Guardian #2 name
  
  First NameLast Name
- Parent/Guardian #2 e-mail
  example@example.com
- Parent/Guardian #2 phone
  Please enter a valid phone number.Format: (000) 000-0000.
- We primarily use a GroupMe text group for communicating with caregivers about upcoming youth events. Do you want to be a part of the GroupMe? We'll use the phone number you shared above.
- Parent/Guardian #2 address (if different)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code

- Youth #1 name*
  
  First NameLast Name
- Youth #1 pronouns
- Youth #1 date of birth*
  
  MonthDayYear
  Date
- Youth #1 grade in school*
- What school does Youth #1 attend?*
- Youth #1 phone number
  Please enter a valid phone number.Format: (000) 000-0000.
- Youth #1 e-mail
  example@example.com
- Youth #1 allergies/dietary restrictions*
- Requested accommodations and/or important health information for Youth #1 (including medications).*
- Youth #2 name
  
  First NameLast Name
- Youth #2 pronouns
- Youth #2 date of birth
  
  MonthDayYear
  Date
- Youth #2 grade in school
- What school does Youth #2 attend?
- Youth #2 phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Youth #2 e-mail
  example@example.com
- Youth #2 allergies/dietary restrictions
- Requested accommodations and/or important health information for Youth #2 (including medications).
- Youth #3 name
  
  First NameLast Name
- Youth #3 pronouns
- Youth #3 date of birth
  
  MonthDayYear
  Date
- Youth #3 grade in school
- What school does Youth #3 attend?
- Youth #3 phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Youth #3 e-mail
  example@example.com
- Youth #3 allergies/dietary restrictions
- Requested accommodations and/or important health information for Youth #3 (including medications).

- Doctor's name*
- Doctor's phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- Health Insurance Information (company, policy #, policy holder's name)*
- We will contact in the order provided. Contact #1 should be a parent/guardian.
- Emergency Contact #1 *
  
  First NameLast Name
- Relationship*
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Emergency Contact #2*
  
  First NameLast Name
- Relationship*
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Emergency Contact #3*
  
  First NameLast Name
- Relationship*
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Emergency Contact #4
  
  First NameLast Name
- Relationship
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.