Southminster Youth Registration 2025-2026

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 2025-26

Allergies

Date of Birth

Date

Youth Name 2

First NameLast Name

Grade in 2025-26

Allergies

Date of Birth

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

NAME OF FAMILY DOCTOR

DOCTOR'S PHONE NUMBER

MEDICAL COVERAGE* (company & policy #)

Please upload a copy of your medical card - front and back

SPC Youth 2025-2026 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

Signed

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

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 emails regarding Youth events directly (without copying you) to your youth?

YesNo

Youth Name 1

Youth Email

example@example.com

Youth Name 2

Youth Email

example@example.com

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 email 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

SOUTHMINSTER PRESBYTERIAN CHURCH