Youth Registration Form 2023/2024

Youth's Name *

First Name

Last Name

Youth's Phone

(###)

###

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Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian's Phone *

(###)

###

####

Alternate Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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I understand that Immanuel makes every effort to maintain a healthy and safe environment. However, I know there are still risks associated with attending group activities, and sometimes unforeseen circumstances. I will not hold Immanuel responsible in the event my Youth experiences sickness or injury as a result of attending Youth Group. *

I agree to the above statement

I will not send my Youth to attend events if they are experiencing any signs of illness. *

I agree to the above statement

Email Updates *

We would like to receive email updates (check all that apply)

Sent to Youth's Email

Sent to Parent/Guardian Email

Do not send updates

Consent to Publish

We occasionally take videos and photographs of our Unlimited Soul Youth Group or Special Events. Do you consent to having your Youth's photo used on our social media platforms and/or website?

Yes

No - If No, I agree it is my responsibility to email hannah@immanueltruro.org to notify staff