Bethia UMC Youth Group Sign Up

All youth wishing to attend youth group must register

The Code of Conduct must be read by both the parent and youth prior to signing up.

Youth Group Registration

This form is used to sign up your youth for Youth Group, and includes transportation permission, medical permission, photography permission and Code of Conduct Sign off

I am registering my youth for the 2023 Youth Group*
- Youth Group 2023
Youth Name*
First Last
Youth Current Age*
Please enter a number from 10 to 18.
Date of Birth*
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Youth's Email
Youth's Phone Number
Select School*
Select Grade
Parent 1 Name*
First Last
Parent 1 Cell
Parent 1 Email*
Parent 2 Name
First Last
Parent 2 Cell
Parent 2 Email
We use a texting app to send out notifications about events, changes, etc. Please check who would like to receive these messages? (Youth will automatically be added)
- Yes - Please add PARENT 1 ONLY
- Yes - Please add PARENT 2 ONLY
- Yes - Parent 1 and Parent 2
LIABILITY RELEASE: In consideration of Bethia United Methodist Church allowing the Participant to participate in children’s ministry activities, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless Bethia United Methodist Church, its directors, employees, volunteers and agents (collectively herein the “Church”) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the activities We (I) the parent(s) or legal guardian(s) of this Participant hereby grant our (my) permission for the Participant to participate fully in children’s ministry activities, including trips away from the church premises. Furthermore, we (I) [and on behalf of our (my) minor youth-Participant(s)] hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this Participant The undersigned further hereby agree to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred as a result thereof. MEDICAL TREATMENT PERMISSION: We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any emergency 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 or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. The undersigned warranted that we (I) have medical insurance coverage for my child. EARLY RETURN HOME POLICY: Should it be necessary for our (my) child to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility. TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for our (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 Bethia. My child and I understand that SEAT BELTS SHALL BE WORN AT ALL TIMES during transportation. PHOTOGRAPHY PERMISSION: The undersigned acknowledges that photographs and/or videos of my child may be taken/recorded during ministry events and gives permission for use of those photographs and/or videos in church publications, displays and websites. By checking the accept box and submitting this form, you agree and understand that all participants are required to follow directions of Bethia UMC Staff, Volunteers, Parents and other adults assisting in ministry activities. Failure to do so, may result in early return home of the participant or inability to participate in future events.*
- Accept Liability
Medical Insurance*
- Yes - We have medical insurance
- No - No we don't have medical insurance
Insurance Company*
Policy / Group ID#*
Does the Youth have any Allergies we need to know about? Check all that apply.*
If any Allergy is marked, please explain last reaction, what signs to look for and course of action required
Does the Youth have any medical conditions we need to know about? Check all that apply.*
If any Medical Condition is marked, please explain any treatment we would need to apply
Medications regularly taken by participant:
I grant permissions for a Youth Group Leader / Volunteer / Chaperone to give the following medications as directed on the bottle to my child.*
Consent*
I agree to the above liability, medication and policy and procedures as stated about. I have also read and reviewed the Code of Conduct with my youth..
Consented to the medications checked above to be given, read and understood the Code of Conduct policy and reviewed it with Youth being registered.
Signature

Bethia UMC Youth Group Sign Up

All youth wishing to attend youth group must register

Youth Group Registration

LOCATION

PHONE NUMBER

CONTACT US TODAY

OFFICE HOURS

Bethia UMC

Contact Us

Call

Directions