Registration Form 2004-2005
Basic Information:
Name:
_________________________________________
Address: _______________________________________
City: ___________________________State: _________
Zip: ______________
Home Phone: ______________________ E-Mail:
________________________
Birthday: _______________
School: ___________________________ Grade:
_________
Parent Information:
Parent’s Names: ____________________ ____________________
Phone Numbers: ____________________ ____________________
Cell Phone Numbers: ____________________ ____________________
E-Mail Address: ____________________ ____________________
Would you be available to
help car pool to a specific event during the year?
Yes, I could help car pool: _____Weeknights _____Weekends
_____ Saturday _____ Sunday
How many youth can fit into
your car/van? _____
The best time to contact me:
__________ At which number: _____
Also, I understand that Christ
the King Church and Youth Group are not responsible for any injury or accident
that is the result of my child’s negligence and that I am fully accountable for
his/her behavior.
_________________________________ _______________________
Parent Signature Date
Emergency Information
IN THE EVENT OF A MEDICAL EMERGENCY, I hereby give my permission for my child to receive any medical treatment as deemed necessary by the attending physician/hospital. In the event of any other emergency, the following person is authorized to act on my behalf, if I can not be reached.
If I cannot be reached please contact: _______________________________________________
Their relationship to the student is: __________________________
Their phone number is: ___________________________________
Is your child taking any medication we should be aware of? _____ Yes _____ No
If yes, please describe: ___________________________________________________________
** Registration Fee:
Please note: There is a registration fee of $20.00, which will be place in a separate account for the Youth Group. This account will help our group financially support service projects as well as social events throughout the year. Also any fundraising done through out the year by the Youth Group will also be placed in this account.
Are you
involved in any other programs? Check
the boxes below:
School Programs: What programs are you involved in?
Music Ministry: Are you involved in any music groups or choir?
Sport Groups: Which have you belonged to?
Church Activities: Are you involved with Altar Services, lectors, ushers, or hospitality?
Other Interests/Hobbies:
Yes, I am interested in being a member of the planning team (Youth Council).