Youth Information Form

Youth Information

Name

Pronouns

She/her/hers He/him/his They/them/theirs Other

If you selected "Other" pronouns, please write in correct pronouns

This address will receive a confirmation email

Home Phone

Cell Phone

Address

Birth Date

School Year

2024 to 2025 2025 to 2026 2026 to 2027

Photo Authorization - I give my permission for First Pres to use the photos of my child for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, social media, and web content. *

Yes No I ONLY authorize the following uses, listed below (e.g. bulletin boards, printed internal newsletters/bulletins, internal email, etc. and/or I give permission for all legal uses IF my child's face is not shown.)

Parent/Guardian Info

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Pronouns

If you selected "Other" pronouns, please write in correct pronouns

Parent/Guardian Address

Parent/Guardian Email

Parent/Guardian Home Phone

Parent/Guardian Cell Phone

Parent/Guardian Work Phone

Relationship to Child

Mother Father Guardian Step-Parent Grandparent Other caregiver

If you selected "Other Caregiver", please write in relationship

Second Parent/Guardian First Name

Second Parent/Guardian Last Name

Second Parent/Guardian Pronouns She/her/hers He/him/his They/them/theirs Other

If you selected "Other" pronouns, please write in correct pronouns

Second Parent/Guardian Address

Second Parent/Guardian Email

Second Parent/Guardian Home Phone

Second Parent/Guardian Cell Phone

Second Parent/Guardian Work Phone

Relationship to Child Mother Father Guardian Step-parent Grandparent Other caregiver

If you selected "Other Caregiver", please write in relationship

Other

When church school is over at 10:15, we need to know if your child will be picked up from class or allowed to leave on their own. Please select the appropriate option and make sure your child is aware of this decision:

Does your child have any allergies, food or otherwise?

Yes No

Please list allergies, and if any action is needed?

Any other information we need to know about your child in order to help them best engage with our programming?

Youth Information Form

Description

Please Fix the Following