Youth Group Registration

Youth Group Registration
Student Information
Student Full Name

First NameLast Name
Preferred Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Grade
School
Student Email Address (if applicable)
example@example.com
Student Cell Phone Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Parent Contact Information
Parent/Guardian (1) Full Name

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

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

First NameLast Name
Additional Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Additional Information
Church Home

Other
Has your student been baptized?
Has your student been confirmed?
Dietary Restrictions
Allergies/Reactions to Allergens
Are there any health issues or chronic medical conditions that our leaders need to be aware of?
Is there anything else you would like to share with us about your student?
Student Covenant of Conduct
In all meetings, retreats, or other events under the sponsorship and/or guidance of Laurel Heights United Methodist Church (“the Church”), I acknowledge that I am responsible for my own actions and am expected to abide by the following:

I will not:
- Humiliate, ridicule, threaten, or degrade anyone;
- Use or possess tobacco and/or vape products, illegal drugs, alcoholic beverages, pornography, or weapons of any kind;
- Use extreme profanity or behave in an objectively inappropriate manner;
- Engage in physical violence of any kind;
- Record or take photos of anyone without their consent.
I will:
- Conduct myself in a manner that makes the youth group, Laurel Heights UMC, and the world a better place;
- Ensure that others around me feel accepted and welcomed;
- Respect others, including but not limited to my peers, staff members, adult volunteers, and physical property.
I, the above named youth, understand the Covenant of Conduct and I agree to abide by it to the best of my ability.
Student Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent Permissions
I authorize Laurel Heights UMC to use photographic or digital representations of my Youth for display in the church, in printed materials, on the church web site and/or social media.
I give permission for staff members at Laurel Heights UMC to contact my student through the following channels
I give permission for volunteers of the youth program at Laurel Heights UMC to contact my student through the following channels
I give permission for my student to participate in the following virtual forums
On behalf of the Youth named herein, I hereby release, relieve, indemnify, and hold harmless the church and its event coordinators, youth leaders, employees, representatives, and agents from any and all liability for any injury, illness, or property damage associated with the Youth’s participation in any activities held on the Church premises or away from the Church premises. I also agree to permit supervision and transportation in accordance with Church policy.

I understand all parts of this agreement.

If the Youth disregards the Covenant of Conduct, a serious attempt to contact all of the previously listed phone numbers will be made and plans to pick up the Youth will be arranged. If I am unavailable for contact or refuse to pick up the Youth, the current most available transportation carrier will be used (at my expense) to return the Youth home.
Parent Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Youth Group Registration

Student Information

Parent Contact Information

Additional Information

Student Covenant of Conduct

Parent Permissions