Youth Registration

Youth Registration Form

Medical permission form required for youth participating in any WPC youth related events, programs, or trips.

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Imago Dei Youth Ministry Medical/Permission Form

This registration form is required for any youth participating in WPC youth ministry events, programs, or trips, including Youth Choir. It provides us with important information for the safety and well-being of your child as they participate in the Imago Dei Youth Ministry of Westminster Presbyterian Church of West Chester.

Child's Name(Required)

First Last

Age(Required)

Grade(Required)

School(Required)

Your Address(Required)

Street Address Address Line 2 City ZIP Code

Child's Email

1st Parent Name(Required)

First Last

2nd Parent Name (if applicable)

First Last

Your Email Address(Required)

Email Address Confirm Email Address

Parent Phone

Emergency Phone(Required)

*Please list the name, relationship & cell number of an emergency contact other than a parent/guardian already listed above.

Best Time to Call You

Insurance Company(Required)

*Please provide company name and your insurance policy number

Medical Issues/Allergies

*Please provide descriptions of any medical or allergy-related issues with your child. And please contact the Director of Youth & College Ministry directly if there are any medications that may need to be administered during youth ministry events, programs, or trips.

Mental Health

*Please provide any information on the mental health of your child if you feel it is beneficial or necessary for the Director of Youth & College Ministry to be aware of.

Is your youth interested in participating in Youth Choir?

Yes

Not at this time

Not sure – please contact me with more information

Does your youth play any instruments?

Permissions

I hereby give permission for my child to participate in Westminster Presbyterian Church, West Chester, PA youth ministry activities and release Westminster Presbyterian Church and the youth ministry leadership in West Chester, PA from any and all liability to me or my child as a result of his/her participation. Also, I understand that Westminster Presbyterian Church or the youth ministry leadership does not assume any responsibility for loss of, or damage to, personal property of participant. I understand that because of the nature of certain events, there may be times where my child will not be directly supervised by an adult.

Photo Release

I grant permission to Imago Dei Youth Ministry and related staff to take photos and video for promotional and ministry-related purposes only (i.e. website, social media, flyers, etc). If I wish to waive this permission, I will contact the Director of Youth Ministry directly via email.

Current Date(Required)

Comments

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