Youth Participation Form

Youth Participation Form

Please fill this out once per 2026-2027 school year for your youth to participate in SMPC youth programming events, retreats, and more! This form is MANDATORY!! Please let us know ASAP about any changes to this information.
Youth Full Name

First NameLast Name
Date of Birth of Youth

MonthDayYear
Date
Parent / Guardian #1 - First and Last Name

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

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Grade Level for the 2026-2027 School Year
What school do you attend?
Who is allowed to pick up your youth from SMPC youth programming events (on church campus and off church campus)? Please list all possibilities...
Does your youth have food allergies? (if none, please leave blank)
Does your youth have dietary restrictions? (if none, please leave blank)
Does your youth have any medical concerns? (if none, please leave blank)
Does your youth have any physical restrictions? (if none, please leave blank)
Name of Emergency Contact #1
Phone Number of Emergency Contact #1
Please enter a valid phone number.Format: (000) 000-0000.
Relationship of Emergency Contact #1 to Youth Participant
Name of Emergency Contact #2
Phone Number of Emergency Contact #2
Please enter a valid phone number.Format: (000) 000-0000.
Relationship of Emergency Contact #2 to Youth Participant
SMPC never posts photos of youth with identifying information, such as their last name. May we use photos of your youth in our online (church social media platforms such as Facebook, Instagram, etc., church website, or electronic church newsletters) and print church publications (printed newsletters or bulletins)?
Do you give permission for SMPC staff and/or approved and background checked volunteers to transport youth off campus for planned local or out-of-town trips?
Electronic Communication with Youth
At SMPC, we use electronic communication to keep youth and families informed about events, schedules, service opportunities, and ministry activities. In accordance with our Child and Youth Protection Policy (CYPP), adult leaders will never engage in one-on-one electronic communication with a minor. Communication may occur through email, text messages, or approved group messaging platforms. You can review the full CYPP by clicking here and can review Apendix C of the CYPP which details the full Parental Consent Form for Electronic Communication by clicking here.

Please indicate your preferences for electronic communication with your youth below.
May SMPC communicate electronically with your youth?
If yes, which methods of communication do you authorize? (Select all that apply.)
Youth Email Address (if applicable)
Youth Cell Phone Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Signature for Electronic Communication Guidelines
Date

MonthDayYear
Date
Should be Empty:

Youth Participation Form

Electronic Communication with Youth