YOUTH FORMS

REGISTRATION FORM

ALL L1UMC YOUTH PARTICIPANTS (Adults or Youth) must have a completed registration form
and a copy of their medical insurance card on file in the student ministry office. L1UMC Student
Ministries Director and volunteers will have access to these forms for all events, trips, or outings.

First Name

Last Name

Address

Phone

Grade

School

Birthday

PHOTO RELEASE: I consent to the photographing or filming of the participant listed above to be used for promotional purposes by First United Methodist Church of Lewisburg.

Parent/Guardian's Initials

PARENT/GUARDIAN INFORMATION

Parent/Guardian 1 Name

Parent/Guardian 2 Name

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Cell Phone

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Cell Phone

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Email

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Email

EMERGENCY CONTACTS

(If parent/guardian(s) cannot be reached)

Emergency Contact 1 Name

Emergency Contact 2 Name

Emergency Contact 1 Phone

Emergency Contact 2 Phone

MEDICAL INFORMATION

Participant Full Name

Name Coverage is Under

Health Care Provider

Policy Number

ID Number

Family Physician Name

Phone

ALLERGIES

SPECIAL NEEDS (physical, dietary, etc.)

MEDICATION LIST

TRANSPORTATION POLICIES (Initial for permission/agreement)

I understand student drivers are not permitted to drive during an L1UMC event. Students may drive to and from meeting place only.

I understand it’s the sole responsibility of the parent/guardian to pre-arrange transportation to and from L1UMC events for my youth.

As the legal parent/guardian of the above youth, I give my permission for L1UMC and its representatives to transport my youth on outings and trips when such trips leave the L1UMC property.

, the legal parent/guardian of the above youth give my permission for him/her to participate in Lewisburg First United Methodist Church (L1UMC) Youth Ministry events. I understand all reasonable safety precautions will be taken at all times by the L1UMC staff and volunteers. I have completed the information to the best of my knowledge.

I understand there are risks inherent with all youth ministry activities and outings. I understand L1UMC, Director of Student Ministries, and other leaders are not liable for damages, losses, illness, or injuries incurred by my youth. In the event that an injury should occur, I give permission for my youth to receive any necessary medical treatment (including but not limited to: transportation to a medical facility, consultation with a medical professional, and any measures deemed necessary by attending personnel should my youth need such treatment before I can be reached.

Parent/Guardian Electronic Signature

Select Today's Date

Parent/Guardian Printed Name

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Registration

L1UMC YOUTH GROUP PERMISSION SLIP

I give

permission to attend

with the Lewisburg First United Methodist Church youth group.

I/We understand all reasonable safety precautions will be taken at all times by L1UMC and its agents during the events and activities. I/We authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of an emergency. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold L1UMC, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.