Youth Events Registration

Please fill out this form and click submit.

Name

This address will receive a confirmation email

Phone

Address

Grade in School

DOB

Other Children

DOB and Grade in School

Other Children

DOB and Grade in School

Parent/Guardian & Relationship

Medical Conditions, Special Needs, And/or Allergies

Emergency Contact

Emergency Contact Phone

If applicable: If my child uses diapers and needs to be changed while in the nursery

Please select all that apply.

I would like to be notified to come and change the diaper I would like a nursery volunteer to make the diaper change

If applicable: If my child in the nursery is potty trained, but needs bathroom help-

Please select all that apply.

I would like to be notified to come and take my child to the restroom. I would like a nursery volunteer to take my child to the restroom.

Due to our number of volunteers, I understand that if I have a child in children's church who needs bathroom assistance, it is my job to come and assist my child with the bathroom.

Please select all that apply.

Yes, I understand

My children have permission to walk home from youth group.

Please select all that apply.

yes no

Who May Pick Up My Children

I give permission for my children's photo/and or video to be used in Chadron Christian Church's social sites.

Please select all that apply.

Yes No

By submitting this form you are agreeing to your child/children's participation in Chadron Christian Church's Youth Programs.

Please check which event you are registering for

Please select all that apply.

Sunday Mornings VBS Wednesday Nights

Description

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Youth Events Registration

Description

Please Fix the Following