Youth & Children's Ministries 2024-2025 Registration Form

Please complete one form for each child.

We look forward to welcoming your family into our programs.

Student Information:

Student Name:

First NameLast Name

Grade:

Birth Date:

MonthDayYear

Family/Household Information:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone number where you can be reached during Sunday school

Area CodePhone Number

Parent/Guardian Information:

Parent/Guardian Name:

First NameLast Name

Cell Phone:

Email

example@example.com

Additional Parent/Guardian Name:

First NameLast Name

Cell Phone:

Email

example@example.com

Program Selections:

10:30 AM Programs for Children

Nursery Ages 0-4 yearsPreschool (potty-trained)Godly Play K - 5th Grade Program

Other Programs

Acolytes - 7 years and olderChildren's Choir - 5 - 14 years oldPathfinders - 4th-6th grade (after 10:30am service)Y.E.S.S. - 7th-12th grade (after 10:30am service)

Parent Participation - please volunteer to help in whatever ways you can. Thanks!

I am available to help:

every weekonce a monthon occasion

Click to edit

I have a special skill I would like to share (guitar playing, story telling, etc.)I would prefer working with Pathfinders/YESS.I would prefer working with Sunday School.

Special Skill

Emergency Contact Information: If I cannot be reached, please contact:

Name

First NameLast Name

Phone Number

Relationship to Student

Allergies, Special Needs, Other Comments: Please list any drug or food allergies or special needs of this student:

Medical Insurance Information:

Physician's Name:

First NameLast Name

Insurance Company:

Name of Policy Holder:

Physician's Phone Number:

Insurance Phone Number:

Policy Numbers:

Authorization for Treatment and Photo Release: The student named above has my permission to participate in St. Stephen's Episcopal Church's Youth & Children's programs, events, field trips, and outings including play on bouncies, water slides, and other equipment. I waive any claim against the church and its approved leaders, teachers, staff, and volunteers. In case of medical emergency, I/we, the parent(s) or legal guardian(s) of the student, a minor, hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment, and hospital care which is deemed advisable by, and is to be rendered under, the general or special supervision of any licensed medical personnel on the staff of any licensed hospital or medical facility at my/our expense. This authorization is given in advance of any specific diagnosis, treatment, or hospital care required, but is given to provide authority and power to call paramedics, transport, and render care which is deemed advisable in the best judgment of the medical personnel. I consent to allow pictures of this child to be used on bulletin boards and in publications (such as handbooks, brochures, fliers, Chapel booklets, newsletters, web pages, Facebook, etc.) unless otherwise noted in the comments section of this form.

Person Submitting this Form:

First NameLast Name

Relationship to Student:

St. Stephen’s Episcopal Church

Youth & Children’s Ministries Policies

(Please read and review the following important guidelines and policies. Thank you.)

•Parents are asked to stay on the premises while their children are here on Sunday.

•Parents are always welcome to stay with their children and participate in our programs.

•There is no charge for any of our programs in Youth & Children’s Ministries

•This is a volunteer supported ministry. Please get involved and volunteer whenever you can. Together we make these program great.

• Parents of preschoolers are asked to stay with them the occasional Sunday at times when we have need for more adult participation.

•Parents of children who are having difficulty separating or are having any behavior problems may be asked to stay and help in the class.

By submitting this form, you acknowledge that you have read the Youth & Children's Ministries Policies, and you give your authorization for treatment and photo release.