Youth Registration - Extended - Shoreline Covenant Church

Youth Registration – Extended

Thank you for completing the following registration form. If you have any questions about this form or the event, please reach out to Shoreline Covenant at 206-542-1050 or office@shorelinecovenant.org!

"*" indicates required fields

Registration Information

Which event are you registering for?*

Other Youth Event

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

Parent/Guardian Consent Form

Please fill out the Youth Parental Consent Form if your participant(s)’ event includes swimming or any overnight stays. You may exit out of this form and complete the Consent Form instead. You can access the Parent/Guardian Consent Form at: https://shorelinecovenant.org/consent If you have already filled out this form, and/or your event does not include swimming/overnights, you may simply complete this form.

Have you previously completed the Parent/Guardian Consent Form?*

Yes

Parent/Guardian Name(s)*

Parent/Guardian Email*

Parent/Guardian Best Phone Number*

Participant #1 Information

Participant's Name*

First Last

Birth Date*

Allergies/Dietary Information*

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

Medical Information*

Are there any medical conditions or medical issues 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

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

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

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.