Children and Youth Ministry Registration Form Child/Youth InformationChild's/Youth's Name* First Last Birth Date* MM DD YYYYAge*As of September 1, 2020Gender*Church Member of*Gables UCCNo ChurchBaptized*YesNoYouth's Cell PhoneYouth's Email Grade*InfantToddlerPreK-2PreK-3PreK-4Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeDuring the 2020-2021 school year.School*During the 2020-2021 school year.Special Interest and Activities*Allergies/Dietary RestrictionsPlease list.Siblings Attending Sunday School*YesNoNames and AgesParent/Guardian Contact InformationParent's/Guardian's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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.*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.I 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 ActivitiesParent's/Guardian's Digital Signature*Date* MM DD YYYY