Fillable Printable Youth Ministry Registration Form - True Vine Ministries

Youth Ministry Registration Form - True Vine Ministries

Youth Ministry Registration Form

Please complete this form for all children participating in children’s ministry.

Last Name First Name DOB Male or

Female

Parent(s)/Guardian(s):____________________________________________________________

Street Address: _________________________________________________________________

City: ____________________________ State: __________Zip code:______________________

Primary Number: ________________________ Secondary Number: ______________________

Email Address: _________________________________________________________________

Emergency Contact: _____________________________________________________________

Relationship to Participant(s): _____________________________________________________

List any court-appointed restrictions:

______________________________________________________________________________

Those authorized to pick up my child are:

______________________________________________________________________________

Youth Ministry Medical Form (Ple ase fill out for each child)

Child’s Name: _________________________________________________________________

A. Does your child experience any of the following (if yes, please explain):

1. Allergies Yes or No Explain___________________________________

2. Heart Condition Yes or No Explain___________________________________

3. Diabetes Yes or No Explain___________________________________

4. Headaches Yes or No Explain___________________________________

5. Seizures Yes or No Explain___________________________________

6. Motion Sickness Yes or No Explain___________________________________

7. Fainting Yes or No Explain___________________________________

8. Upset Stomach Yes or No Explain___________________________________

9. Other: (please list)_______________Explain:___________________________________

B. Does your child have a reactionto(if yes, please explain):

1. Bee Stings Yes or No Explain___________________________________

2. Penicillin Yes or No Explain___________________________________

3. Medications Yes or No Explain___________________________________

4. Poison Ivy/Oak Yes or No Explain___________________________________

5. Peanuts Yes or No Explain___________________________________

6. Other: (please list)_______________Explain:___________________________________

Youth Ministry Medical Form cont.

C. Please answer the following:

1. Does your child have any condition that would prevent him/her in participating in any

activities? Yes or No (If yes, explain)

________________________________________________________________________

2. Does your child take any prescription medications? Yes or No (If yes, explain)

________________________________________________________________________

3. Does your child have any sight or hearing impairment? Yes or No (If yes, explain)

________________________________________________________________________

4. Has your child been diagnosed with any mental health condition? Yes or No (If yes,

explain) ________________________________________________________________

Please indicate any other pertinent information that the youth staff should know about your child:

______________________________________________________________________________

By signing below, I confirm that all the information listed on this form is truthful and accurate. I

understand that the youth ministry is concerned about the health and safety of my child and will

follow the guidelines of this form in concerns to my child. I understand that neither the youth

ministry, nor does True Vine Ministries accept any responsibility in the event that my child gets

hurt or sick.

PLEASE SIGN:

(Parent/Guardian) (Date)

PERMISSIONSLIP

PERMISSION/MEDICAL RELEASE FOR

NAME______________________________________PHONE__________________________

ADDRESS_____________________________CITY___________________________________



ZipCode_________________Birthdate_____/_____/_____Grade___________________



School_______________________________________________________________________



PARENT/GUARDIAN’SNAME______________________________________________________

VISITOR?WHOINVITEDYOU?____________________________________________________

IGIVEPERMISSIONFORMYCHILDTOJOINTHEYOUTHOFTRUEVINEMINISTRIESOFFAYETTEVILLE,NC,INANYOF

THE ACTIVITIES OR TRIPS SPONSORED BY THE CHURCH

, ITS STAFF AND SPONSORS.I HEREBY RELEASE THEM FROM

RESPONSIBILITYAND LIABILITY FOR ANY ILLNESS  ORINJURY THAT MY CHILD MAY SUSTAIN DURING THISACTIVITY

.IN

THE EVENT OF  AN EMERGENCY

, I HEREBY AUTHORIZE AN ADULT LEADER OF THIS ACTIVITY AS AGENT FOR ME, TO

CONSENT TO ANY X

‐RAY EXAMINATION, ME DICAL, DENTAL, OR SURGICAL DIAGNOSIS, TREATMENT, AND HOSPITAL

CARE ADVISED AND SUPERVISED BY A PHYSICIAN

, SURGEON, DENTIST (AS APPROPRIATE), LICENSE D TO PRACTICE

UNDERTHELAWSOFTHESTATEWHERESERVICESARERENDERED

,EITHERATADOCTOR’SOFFICE ORINANYHOSPITAL.

IEXPECTTOBECONTACTEDASSOONASPOSSIBLE. 

ARENT’S

SIGNATURE:_________________________________________________________________

Today’sDateMonth______________________Day________________Yr_________________



EMERGENCYPERSONS&PHONENUMBERS:

NAME:___________________________________________

PHONE#____________________________

NAME:____________________________________________PHONE#_______________________



MEDICALINFORMATION:(REQUIREDFORALLOFF‐CAMPUSACTIVITIES)

ALLERGIES

___________________________________________________________________________

MEDICATIONSBEINGTAKEN

____________________________________________________________

PHYSICALHANDICAPS

_________________________________________________________________

MEDICALINSURANCECO.

______________________________________________________________

NAMEOFPOLICYHOLDER_____________________________POLICY#______________________

OU WILL NOT BE ALLOWED TO GO ON ANYYOU THTRIPOFF‐CAMPUS WITH TRUE VINE MINISTRIES WITHOUT A

PERMISSIONSLIPSIGNEDBYYOURPARENT

/GUARDIANONFILE.

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YOUTH MINISTRY GUIDELINES

The following are the guidelines of the Youth Ministry of True Vine Ministries. These guidelines are in the

best interest of the total ministry of the Church and they will be firmly, yet lovingly, enforced.

1. Enjoy yourself.

2. Youth will respect the authority of each adult involved in the Youth Ministry. In the event that this

respect is not given, parents will be immediatelyinformed.

3. In light of the spiritual focus of the Youth Ministry, only Christian music will be played on trips. (The

use of any personal listening devices will be at the discretion of the Youth Leaders.)

4. Modest one-piece swimsuits for girls and shorts and T-shirts for guys will be the standard for any

pool or water activities. Chaperones will decide on questionable attire.

5. Everyone’s shorts are to be school standard (finger-tip level while standing with arms extended

straight down). Biking shorts will be worn only underneath "finger tip" shorts.

6. T-shirt messages are to be wholesome. (The Christian lifestyle does not promote the lifestyle of

most secular society.)

7. No draping, hanging on, sitting on, or kissing between students.

8. Use trash containers provided. Please don’t throw trash anywhere other than the containers

provided. All groups will clean the vehicles and facilities used before the end of the trip or program.

9. For your safety, do not wander the halls or parking lots. Please be at all scheduled activities you

are involved in. (Parents will be notified by the Youth Pastor for infractions of this rule.)

10. No tobacco products, alcohol, or other controlled substances.

 If a discipline problem is deemed serious enough, the youth will be sent home at the parent’s

expense.

 I have read and agree to follow these guidelines.

__________________________________________  __________ _______________

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YouthSignature Date

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