Youth Ministry Registration Form

• 1st Student's Name*
  FirstLast
• Untitled*
  • Male
  • Female
• Birth Date
  Month123456789101112

  Day12345678910111213141516171819202122232425262728293031

  Year20142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• Student Cell Phone
• I would like to receive text message reminders*
  • Yes
  • No
• If Yes, list Cell phone provider
• Student Email
• Special Needs (allergies, medical concerns etc.)
• School*
• Core
  • 6th Grade
  • 7th Grade
  • 8th Grade
• Tower
  • 9th Grade
  • 10th Grade
  • 11th Grade
  • 12th Grade
• 2nd Student's Name
  FirstLast
• Gender
  • Male
  • Female
• Birth Date
  Month123456789101112

  Day12345678910111213141516171819202122232425262728293031

  Year20142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• Student Cell Phone
• I would like to receive text message reminders
  • Yes
  • No
• If Yes, list Cell phone provider
• Student Email
• Special Needs (allergies, medical concerns etc.)
• School
• Core
  • 6th Grade
  • 7th Grade
  • 8th Grade
• Tower
  • 9th Grade
  • 10th Grade
  • 11th Grade
  • 12th Grade
• Parent #1*
  FirstLast
• Cell Phone*
• I would like to receive text message reminders*
  • Yes
  • No
• If Yes, list Cell phone provider
• Email*
• Parent #2
  FirstLast
• Cell Phone
• I would like to receive text message reminders
  • Yes
  • No
• If Yes, list Cell Phone Provider
• Email
• Address*
  Street AddressAddress Line 2CityZip / Postal Code
• Parent Involvement - I would consider serving in Youth Ministries in the following areas:
  • Small Group Leader
  • Check-in/Greeter
  • Tech Team
  • Snack Shack Helper
  • Special Event Volunteer
  I would consider serving in Youth Ministries in the following areas

• Medical Release

  I give permission for my child to participate in all aspects of Youth Ministries both on and off site. I understand that every effort will be made to contact me if my child needs emergency medical treatment. I authorize medical personnel of COH staff to secure any medical or emergency treatments as deemed necessary for my child. I or my insurance company will pay for any medical treatment if costs are incurred.

• Behavior Clause

  In the event that my son or daughter behaves in a manner in which the adult leaders feel it is necessary for him/her to leave an event, I will take full responsibility for cost and arrangements to pick up or send home my son or daughter.
• Please type your name as an electronic signature for Medical Release/Behavior Clause*

• Parent Permission

  I give permission for my child's image to be used in any Community of Hope publication, or promotional material including the COH website.
• Please type your name as an electronic signature for Parent Permission*