Children and Youth Formation Registration, Media and Medical Release

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2023-24 Sunday School Registration and Photo Release

This form give permission for your child(ren) to participate in Eastern Shore Chapel's Sunday School program led by Safe Church certified volunteers. Parents/Guardians may only register their own child(ren). The Sunday School time is from 9:15 am - 10:15 am most Sundays.

Questions? e mail faithformation@easternshorechapel.org

Parent/Guardian Name* *

Email *

Home Phone *

Cell Phone *

Street Address *

City, State, and Zip Code *

Child/Youth #1

Name

Grade *

School *

Birthday *

YYYY

Baptized *

Confirmed *

Special information about your child (i.e. allergies, medications, special needs, interests, etc.) *

Child/Youth #2

Name

Grade

School

Birthday

YYYY

Baptized

Confirmed

Special information about your child (i.e. allergies, medications, special needs, etc)

Child/Youth #3

Name

Grade

School

Birthday

YYYY

Baptized

Confirmed

Special information about your child (i.e. allergies, medications, special needs, etc)

Medical, Photo and Media Release

In the event that my child becomes ill or is injured, I authorize the Eastern Shore Chapel Staff to act for me according to their best judgement to respond to the illness/injury. I grant permission for my child to be given treatment at a local hospital if necessary.

Yes

Required

Do you grant permission for your child(ren) to participate in Eastern Shore Chapel's virtual formation programming via ZOOM if necessary? *

Yes

Do you grant permission to Eastern Shore Chapel to use your child(ren)'s photo in ESC publications and electronic media platforms? *

Yes

Does your child(ren) need a nametag? (children's nametags have full first name and last name initial only) *

Parent/Guardian signature *

Date *

YYYY

Submit

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