Bethany Covenant Youth Ministry - Registration 2023-24

Parent/Guardian Info

Parent 1 Name

Address

Phone

This address will receive a confirmation email

Would you like to receive weekly updates of Bethany Youth events?

Yes, through email Yes, through text No thank you

Parent/Guardian 2 Name

Address (If different from above)

Phone

Would you like to receive weekly updates of Bethany Youth Events? Yes, through email Yes, through text No

Student Info

Student 1 Name

Address

Phone

Would your student like to receive weekly updates about Bethany Youth events?

Yes, through email Yes, through text No thank you

Allergies, Dietary, Medical restrictions

Medications

Any other special needs or concerns?

Student 2 Name

Phone

Would your student like to receive weekly updates about Bethany Youth events? Yes, through email Yes, through text No

Allergies, Dietary, Medical restrictions

Medications

Any other special needs or concerns?

Student 3 Name

Phone

Would your student like to receive weekly updates about Bethany Youth events? Yes, through email Yes, through text No thank you

Allergies, Dietary, Medical restrictions

Medications

Any other special needs or concerns?

Emergency Contact

Name

Phone

Relationship

Health Insurance Info

Insurance Provider

Group Number

Primary Physician

Phone

People Authorized to Pick-Up

Please list all those who are authorized to pick up your student/s after Youth Group events. Adults will be asked to present a license at pick up from retreats, special events, or if they are not recognized by youth volunteers.

Permission Slip 2023-24

I hereby give permission for my child to attend and participate in Bethany Covenant Church’s youth ministry events and activities from September 24, 2023 to September 24, 2024. I give permission for my child to be driven in a vehicle by a licensed adult from Bethany Covenant for the purpose of these events and activities. I understand that there are inherent risks involved in any such activity, and I hereby release Bethany Covenant Church, its staff and volunteer workers from all liability due to any injury, loss, or damage to person or property that may occur during the course of my child’s involvement. My digital signature also gives permission to the adult leaders/chaperones to act on my behalf to secure full emergency medical treatment should they not be able to reach me/us at one of the emergency numbers provided. As a parent or guardian, I am aware of my responsibility to instruct my child on the importance of appropriate conduct which will ensure safety and an enjoyable time for all while participating in this activity. I grant permission with confidence that my son/daughter will cooperate with the ground rules and instructions for appropriate behavior given by adult leaders of Bethany Covenant Church.

I represent that I am the parent/guardian of the above child, who is under 18 years of age. I have read the Permission Form and I am fully aware of its contents.

yes

I give permission for photos of my child to be used on the Bethany Covenant Church website or affiliated social media sites.

yes no

Parent's Typed Signature

Today's Date

*The Remind app is a group texting platform used by school systems. By signing up to receive group texts, students and parents can receive text updates about upcoming events. Your phone number will not be visible to other members of the group. Any texts you send in reply are seen only by the youth director.

Bethany Covenant Youth Ministry - Registration 2023-24

Description

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