Youth Ministry Registration & Consent Form 2026/2027

Youth Information:

Name

Birth Date

Grade

School

Address

Cell Phone

Youth will never be contacted by Youth Ministries Director without also contacting parent as well, and youth cell will not be shared with others (unless consent is given first)

Youth Email

T-Shirt Size (Adult Sizes)

Allergies/Medical Conditions

What activities are you involved in? (If you play any instruments/sing, please let me know that here as well!)

I (Colin) would love to try to make it to at least one activity for each youth each semester. This will help me know what schedules I can keep my eyes out for/give me another way I can be praying over each of the youth.

Anything else that would be helpful for the Youth Ministries Director to know about your youth?

Parent or Guardian's Information:

First and Last Name

This address will receive a confirmation email

Cell Phone

Address (if different from above)

Second Parent or Guardian's Information:

First and Last Name

Cell Phone

Address (if different from above)

Additional Information:

Emergency Contact (Other than Parent/Guardian)

Emergency Contact Cell Number

Consent and Certification:

I authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. I also understand that every attempt will be made to notify parents or guardians before procedures proceed. I understand that I will be liable and agree(s) to pay all costs and expenses incurred in connections with such medical and dental services rendered to the aforementioned child pursuant to this authorization.

Yes No

Should it be necessary for my child to return home due to medical reason, disciplinary action or otherwise, I hereby assume all transportation costs. I also herby give permission for my child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Powell UMC.

Yes No

I hereby give permission for Powell UMC staff or youth volunteers to drive my child to and from any events that are offsite from the church. This includes any mission, fellowship, retreat, or any other types of events that may be scheduled.

Yes No

I hereby give permission for Powell UMC, ministers, staff, leadership and/or volunteers to use photos of my child in church publications such as church emails, church website, social media or other church related needs.

Yes No

I hereby give permission for the church to contact my child via email and/or text messages as a means of communication, knowing that I will also be made aware if communications are sent to them directly.

Yes No

By typing your name below, you give permission for your child to attend and participate in activities and events sponsored by Powell United Methodist Church to be held on church premises and/or at off-site locations. I understand that I will be notified of specific details for all activities/events. This permission is granted for the 2026-27 program year (6-1-2026 to 8-31-2027).

Date:

Youth Pledge:

I hereby pledge to uphold all policies of the Youth Ministries of Powell UMC. During all youth activities and all youth trips, I pledge to follow all instructions of the youth leader and the adult chaperones, including safety instructions. (Youth will sign)

Date:

Youth Ministry Registration & Consent Form 2026/2027

Description

Please Fix the Following