Child & Youth Registration Form
This form helps us get to know your family and have important information for connecting you further with our children's and youth ministry.  It also gives us vital information in the event of an emergency.  If there is further information you'd like to share with us that would benefit us in serving your family, please contact Pastor Carrie Antczak.
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Parent(s) Full Name *
Street Address
City/State/Zip Coke
Mobile Phone *
May we send you reminders via text message using the "Remind" app?
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Parent Email Address *
Alternate/Emergency Contact & authorized pick-up adult name
Phone Number
Child/Youth's Full Name *
Pronouns
Date of Birth *
MM
/
DD
/
YYYY
Grade/Class *
Does your child/youth have any special needs or concerns you would like to share with us?
Does your child/youth have any allergies?
Please share your child/youth's special interests and abilities:
My child/youth  may be photographed for church related promotions *
In the event of an emergency, I authorize first aid or medical treatment for this minor and I release The United Methodist Church of Berea from any and all responsibility in connection therewith. (Please enter your name as your signature, followed by the date signed.) *
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