Youth Registration

Registration Information

Which event are you registering for?*

Jr. Hi Christmas Lights Tour
Rooted (Sr. Hi) Black Nativity
Other Youth Event

If you choose "Other Youth Event" please list event here:

Do you have a Parental Consent Form on File*

Yes
No

** Parental Consent Form*

Please fill out the Youth Parental Consent Form if your participant(s) event includes swimming, going off campus, or involves any overnight stays. If you have already filled out this form you may type in N/A. Link to Parental Consent Form : https://shorelinecovenant.org/parental-consent-form/

Parent/Guardian Name(s)*

Parent/Guardian Email*

Parent/Guardian Best Phone Number*

Participant #1 Information

Participant's Name*

First Last

Birth Date*

Dietary Information*

Are there any food allergies or dietary restrictions we should be aware of? If so, please describe. If not, enter “NA” or “None”.

Medical Information*

Are there any allergies or medical conditions that we should be aware of? If so, please describe. If not, enter “NA” or “None”.

Other Information*

Are there any special needs or additional information that we should be aware of to help your child have a safe, fun time at this event? If so, please describe. If not, enter “NA” or “None”.

Do you have >1 child to register?*

Yes
No

Participant #2 Information

Participant's Name*

First Last

Birth Date*

Dietary Information*

Are there any food allergies or dietary restrictions we should be aware of? If so, please describe. If not, enter “NA” or “None”.

Medical Information*

Are there any allergies or medical conditions that we should be aware of? If so, please describe. If not, enter “NA” or “None”.

Other Information*

Are there any special needs or additional information that we should be aware of to help your child have a safe, fun time at this event? If so, please describe. If not, enter “NA” or “None”.

Do you have >2 children to register?*

Yes
No

Participant #3 Information

Participant's Name*

First Last

Birth Date*

Dietary Information*

Are there any food allergies or dietary restrictions we should be aware of? If so, please describe. If not, enter “NA” or “None”.

Medical Information*

Are there any allergies or medical conditions that we should be aware of? If so, please describe. If not, enter “NA” or “None”.

Other Information*

Are there any special needs or additional information that we should be aware of to help your child have a safe, fun time at this event? If so, please describe. If not, enter “NA” or “None”.

Do you have >3 children to register?*

Yes
No

Participant #4 Information

Participant's Name*

First Last

Birth Date*

Dietary Information*

Are there any food allergies or dietary restrictions we should be aware of? If so, please describe. If not, enter “NA” or “None”.

Medical Information*

Are there any allergies or medical conditions that we should be aware of? If so, please describe. If not, enter “NA” or “None”.

Other Information*

Are there any special needs or additional information that we should be aware of to help your child have a safe, fun time at this event? If so, please describe. If not, enter “NA” or “None”.

Emergency Contact Information

If parent cannot be reached at the numbers above, please list two people that your child can be released to in the event of an emergency.

List*

Phone #	Name	Relationship

Electronic Signature and Permissions*

By inputting my initials above, I certify that I understand that my child will be participating in a number of activities which carry with them a certain degree of risk. Some of the activities may include, but are not limited to: hiking, climbing, running, sports and other activities which the church may offer. I consent for my child to participate in these activities. I also represent that my child is of adequate health to safely participate in these activities. It is my understanding that the church will attempt to notify me in case of a medical emergency involving my child. If the church cannot reach me, then I authorize the church to hire a doctor or other health-care professional, and I give my permission to the doctor or other health-care professional to provide the medical services he or she may deem necessary. I will pay for any medical expenses so incurred. I will notify the church if I feel there are any health considerations that would prevent my child’s participation in any activity. I also give my permission for the appropriate ministry leader to restrict my child from participation in any activity which they have any question about for health or other reasons. I hereby release Shoreline Covenant Church from any liability in the event of injury/illness.

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