25-26 SPC Children/Youth Registration Form

Children & Youth Registration
Child/Youth's Legal Name

First NameLast Name
Grade
Date of Birth

MonthDayYear
Date
I hereby give permission for my child (named above) to participate in Swarthmore Presbyterian Church (SPC) activities from September 1, 2025, to August 31, 2026, and release SPC from any and all liability to me or my child as a result of their participation. I understand that SPC does not assume any responsibility for loss of, or damage to, personal property of participants. In case of emergency, if I cannot be reached, I give my permission to the adult leaders of an event to permit hospital personnel and/or a licensed physician to perform emergency treatments and inject or administer medications in conjunction with such emergency treatment.
Signature of Parent or Legal Guardian
Date

MonthDayYear
Please select if you wish to allow SPC to use photos and/or videos from SPC activities for SPC publications (including social media). Please know that minors are never identified by name in any SPC publications.
Parent/Guardian Information

Adult 1
Name

First NameLast Name
Relationship to Child
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone Number (if Applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Email
Address

Street Address, Including any unit numbers, etc

Street Address Line 2

CityState

Zip Code
Parent Guardian Information

Adult 2
Name

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone Number (if Applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address, Including any unit numbers, etc

CityState

Zip Code
Child/Youth Information
Legal Name

First NameLast Name
Preferred Name

First NameLast Name
Cell Phone
Format: (000) 000-0000.
Email
Allergies
Food Restrictions
Medications
Address

Street Address, Including Unit Numbers, Etc.

Street Address Line 2

CityState

Zip Code
Child/Youth's T-Shirt Size
What else should we know about your child
Who else may pick up this child from Sunday School or church events?
Do you give permission for your child to leave Godly Play/Youth Group and go to Fellowship Hour/Home unattended?
Insurance Carrier
Plan Code
Identification Number
Group Number
Primary Carrier person under whose name the coverage exists
Should be Empty:

Children & Youth Registration

Parent/Guardian Information

Parent Guardian Information

Child/Youth Information