Youth Ministry Registration Form

Youth name *

First

Last

Legal guardian names *

Legal guardian email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Legal guardian phone *

Youth cell phone

This is so the church can communicate with your child.

May SCCC use photos of your child?

Youth insurance information *

Group, ID, Insurance company, and doctor.

If we cannot reach you, does SCCC have permission to obtain medical treatment for your child? *

If it is deemed medically urgent, care will be ultimately provided.

Does SCCC have permission to take your child/youth on activities and trips? *

We cannot take your child anywhere without your permission. Thanks.

Phone