• Child's Information

  • Date of Birth*
     - -

  • NOTE - Children need to have be enrolled in full day TK or preschool in 2026/27 to be eligible to participate in youth programs. All participants must be able to follow instructions, remain with a group, and take care of personal hygiene/toileting independently. 

  • Parent/Guardian Information

    Please list either one or two primary caregivers
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Emergency Contacts/Authorized Pickup

    Parents/guardians cannot be listed as emergency contacts. List the name of at least two people who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within 30 minutes of the Red Shield, able to take responsibility for your child in case the parent/guardian cannot be contacted and be at least 18 years of age.

  • Emergency Contact #1

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Emergency Contact #2

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Medical / Health Information

  • Does your child have any food, medication or environmental allergies?*
  • Allergies? Check all that apply
  • 0/150
  • Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*
  • Does your child have a special health or medical condition?*
  • 0/150
  • Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?*
  • 0/150
  • 0/200
  • 0/200

  • About Your Child

    We want your children to be able to settle well into youth programs, please help us get to know your child a little through answering the following questions!
  • My child has been to Youth Programs in the past (Red Shield or elsewhere):*
  • At drop off, my child is usually:*
  • Dinner is provided as part of Youth Programs, will your child be eating dinner?*
  • Can your child follow instructions, stay with a group and use the restroom independently?*

  • Tuesday Afternoon Programs

    All children participate in an elective. These classes are limited in space and final selections will be made when you attend on September 8th. To help us allocate leaders, please select the electives your child would be interested in. Note, all children in preschool/Kindergarten will be in the Sparklers group. If your child has no musical knowledge or experience, we HIGHLY recommend the Music Explorer option.
  • My child would be interested in (Select up to 3):*

  • Singing Company

  • Singing Company is a choir for kids who love to sing and perform. Rehearsals take place after electives from 6:00–6:30 PM. The musical pieces are more complex, and while no prior experience or special skills are required, participants are expected to:

     

    • Remain focused for the full rehearsal
    • Participate by singing
    • Put forth their best effort
    • Be respectful and avoid distracting others during rehearsals
    • Participate in performances/select extended rehearsals if needed
       

    If your child enjoyed being part of the musical and is ready for a new challenge, Singing Company may be a great fit. If your child does not enjoy singing, they may be picked up at 6:00 PM.

    Note: Younger siblings may remain in Sparklers until 6:30 PM to allow for a single pick-up time if an older child is participating in Singing Company.

  • My child would like to participate in Singing Company (Youth Choir)?

  • CODE OF CONDUCT AND BEHAVIOR

    I understand that all children are expected to participate in activities under the guidance of trained volunteers/employees of The Salvation Army. Participation includes following instructions, using respectful language and actions, and not jeapordizing the safety of themselves, other children, or adults in any way. Any child who is unable to do so will be required to take a break from programming, with reentry determined by a meeting of parent and the Corps Officers.

    Functions and Activities

    It is my understanding that participating in the programs, recreational and other activities of The Salvation Army is a privilege. Prior to participation in such activities, I acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness or even death. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware.

    Release of Liability

    By signing this Permission/Waiver Form, I expressly warrant that the child/ren named above is capable of withstanding both the physical and mental demands of the activities discussed above, I also expressly assume all risks of the child/ren or me participating in the activities, whether such risks are known or unknown to me at this time. I further release The Salvation Army and its staff, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the child(s) or my family or estate, heirs, representatives, or assigns may have against The Salvation Army or its staff, volunteers or agents. I further agree to indemnify and hold harmless The Salvation Army and its staff, volunteers or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities.

    First Aid and Emergency Medical Treatment

    I recognize that there may be occasions where the child/ren mentioned above or I, if I am a participant, may be in need of first aid or emergency medical treatment as a result of an accident, illness or other health condition or injury. I do here by give permission for the agents of The Salvation Army to seek and secure any needed medical attention or treatment for the child/ren named above or me, if I am a participant, including hospitalization if in the agent’s opinion such need arises. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery, and again, I agree to pay for the medical treatment.

    Publicity

    On occasion, The Salvation Army takes photographs or makes an audio or videotape recording of children and/or adults involved in unit activities. Such photographs or video records may be used by staff and participants to remember the activities and participants. In addition, such photographs and audio/visual recording may be used in The Salvation Army publications or advertising materials to let others know about our ministry. In addition, local news organizations may hear of our activities or events; and The Salvation Army may invite or allow them to photograph or record our events for news reporting on special interest features. I consent to the use of any such audio or visual record of the child/ren named above or me, if I am participating, to be used, distributed, or displayed as agents of The Salvation Army see fit. This consent includes but is not limited to: photographs, videotapes, and audio recordings. Furthermore, I give permission for the child/ren to be interviewed by the news media or for such photographs and other audio or visual records to be used by the news media.

     

    This Consent Agreement must be signed by the Parent/Guardian for ALL delegates under the age of 18.

    Consent Agreement:

    The undersigned, being the person having legal custody of the above individual who is a minor, hereby authorizes The Salvation Army, Territorial Headquarters, Long Beach, California, acting through any adult personnel thereof, into whose care the said minor has been entrusted, do consent to any X-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to said minor under the general or special supervision and upon advise to a physician and surgeon licensed under the provision of the State Medical Practice Act or to consent to an X-ray, examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor by a dentist licensed under the provision of the State Dental Practice Act.

     

  • I give permission for my child to participate in Youth Programs and activities at The Salvation Army East County Red Shield from September 2026-September 2027:*
  • Sign Document*
  • Date Signed*
     - -
  • Should be Empty: