Y.E.S. Registration form | Shiloh Baptist Church (New Site)

SECTION 1: Child / Youth Information

Child’s Full Name

Preferred Name/Nickname

Date of Birth

Month

Day

Year

Age

Grade (Current)

Current School

SECTION 2: Parent / Guardian Information

Primary Parent/Guardian

Full Name

Relationship to Child

Phone Number

Email Address

Address

Secondary Parent/Guardian (if applicable)

Full Name

Relationship to Child

Phone Number

Email Address

Address

SECTION 3: Emergency Contact (Other Than Parent/Guardian)

Full Name

Relationship to Child

Phone Number

SECTION 4: Medical Information (Confidential)

Medical Conditions

None

Yes

If yes, please explain

Allergies (food, medication, environmental)

None

Yes

If yes, please list

Medications required during activities

None

Yes

If yes, please list medication, dosage, instructions

Does your child carry an EpiPen or inhaler?

No

Yes

Additional medical or behavioral considerations

SECTION 5: Participation & Emergency Medical Consent

I give permission for my child to participate in youth ministry activities sponsored by Shiloh Baptist Church (New Site). I understand that reasonable precautions will be taken to ensure the safety and well-being of all participants. In the event of illness or injury, I authorize Shiloh Baptist Church (New Site) and its representatives to secure emergency medical intervention for my child if I cannot be reached. I understand that every effort will be made to contact me prior to such intervention when possible.

Full Name

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date

Month

Day

Year

SECTION 6: Transportation Permission

Please check all that apply

I give permission for my child to be transported to and from Shiloh Baptist Church (New Site)–sponsored activities by church-approved drivers.

I give permission for my child to be transported by church vans, buses, or other approved vehicles.

I give permission for my child to be transported by adult volunteers using personal vehicles when necessary.

I do NOT give permission for my child to be transported except by me or another authorized guardian.

Parent/Guardian Initials

SECTION 7: Off-Site Activity & Liability Waiver

I understand that participation in off-site youth ministry activities (including but not limited to retreats, mission trips, service projects, outings, and special events) sponsored by Shiloh Baptist Church (New Site) involves inherent risks. I voluntarily give permission for my child to participate in all church-sponsored off-site activities and agree to release and hold harmless Shiloh Baptist Church (New Site), its leadership, employees, and volunteers from liability for accidental injury or loss, except in cases of gross negligence. I understand that parents/guardians will be notified of major off-site events in advance whenever possible.

Parent/Guardian Initials

SECTION 8: Permission to Photograph / Media Release

Please check one

YES, I give permission for my child to be photographed and/or recorded (photo, video, or audio) during Shiloh Baptist Church (New Site) youth ministry activities. Images may be used for church publications, website, social media, presentations, and promotional materials.

NO, I do not give permission for my child to be photographed or recorded.

I understand that my child’s name will not be published without additional consent.

Parent/Guardian Initials

SECTION 9: Code of Conduct & Acknowledgement

I acknowledge that my child is expected to follow the youth ministry code of conduct and

demonstrate respectful, Christ-centered behavior. I understand that behavioral concerns may be

addressed with parents/guardians to maintain a safe, supportive, and faith-based environment at

Shiloh Baptist Church (New Site).

Parent/Guardian Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date

Month

Day

Year

Notes

Youth Participation Registration Form

SECTION 1: Child / Youth Information

SECTION 2: Parent / Guardian Information

SECTION 3: Emergency Contact (Other Than Parent/Guardian)

SECTION 4: Medical Information (Confidential)

SECTION 5: Participation & Emergency Medical Consent

SECTION 6: Transportation Permission

SECTION 7: Off-Site Activity & Liability Waiver

SECTION 8: Permission to Photograph / Media Release

SECTION 9: Code of Conduct & Acknowledgement

Social Media