Children and Youth Ministry Registration Form Child/Youth InformationChild's/Youth's Name* First Last Birth Date* Month Day YearAge*As of September 1, 2022Gender*Church Member of* Gables UCC No Church Baptized* Yes NoYouth's Cell Phone (if applicable)Youth's Email (if applicable) Grade*During the 2022-2023 school year. Infant Toddler PreK-2 PreK-3 PreK-4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th GradeSchool*During the 2022-2023 school year.Special Interest and Activities*Allergies/Dietary RestrictionsPlease list.Siblings Attending Sunday School* Yes NoNames and AgesParent/Guardian Contact InformationParent's/Guardian's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneCell Phone*Email* Second Parent's/Guardian's Name (if applicable) First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneCell PhoneEmail Additional information that would assist us in ministering to your child/youth:*Does your child/youth have any disability of which we should be aware in order to best serve your child/youth? ALL INFO REMAINS CONFIDENTIAL.*If not, please type "No."Emergency Contact InformationName* First Last Relationship to child*Home PhoneCell Phone*Name First Last Relationship to childHome PhoneCell PhoneName of Health Insurance Company*Policy Number*Medical Consent* I authorize medical treatment for my child in case of accident or illness if the parent/guardian cannot be located and an emergency situation arises.Media ReleaseMedia Release* I give permission to use my child's name, photograph, and/or performance recordings (including audio and/or video forms) in brochure, web, and other promotional materials.Health AgreementI agree to the following:* It will be each parent’s responsibility to ensure their child is well and free of fever before attending Children & Youth ministry events. If your child is not feeling well or has a fever of 100 degrees F or higher, Gables UCC requests that they remain home until their fever has ended. Further, should anyone in your family have a positive COVID-19 test before or after attending a church event, please email or call Pastor Megan. Your communication with Pastor Megan will be private and your confidentiality will be protected.Volunteer InterestsI would like to volunteer for Sunday School (choose which area you would like to help). Sunday School Teacher Sunday School Assistant Teacher Sunday School Substitute Teacher Music Helper Christmas Program Volunteer Craft or Service Project Helper Write Monthly Birthday Cards Staff Nursery Once a Month Plan Family Social Activities Plan Nursery Activities Chaperone for Youth ActivitiesSignatureParent's/Guardian's Digital Signature*Date* Month Day Year
