Children and Youth 2024–2025 Program Registration - East Liberty Presbyterian Church

Step 1 of 3

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Parent/Guardian Name (1)*

First Last

Phone

Can we text this number?

Yes

Parent/Guardian Name (2)

First Last

Email (Parent/Guardian 2)

Phone (Parent/Guardian 2)

Can we text this number?

Yes

Preferred Mailing Address

Street Address Address Line 2 City State ZIP Code

Student's Information

Student's Name*

First Last

Grade Entering*

Date of Birth

MM slash DD slash YYYY

Preferred Pronouns

Student's Email Address (if applicable)

Student's Cell (if applicable)

Please select the programs/activities your student is interested in*

Nursery on Sunday mornings

Sunday School

Club One Sixteen for kids in grades 1–6 on Wednesday evenings

Tween Programs for grades 4–6

Teen Programs for grades 7–12 (includes Youth Group on Thursday nights and weekend events)

Learn more about these programs at https://cathedralofhope.org/ministries-programs/children-youth-ministries/overview/

Does the student have any allergies (food or environmental)?

Special Considerations for Student

Do you have a second student to register?*

Yes

Hidden

Second Student's Information

Second Student's Name*

First Last

Grade Entering*

Date of Birth

MM slash DD slash YYYY

Preferred Pronouns

Student's Email Address (if applicable)

Student's Cell (if applicable)

Please select the programs/activities your student is interested in*

Nursery on Sunday mornings

Sunday School

Club One Sixteen for kids in grades 1–6 on Wednesday evenings

Tween Programs for grades 4–6

Teen Programs for grades 7–12 (includes Youth Group on Thursday nights and weekend events)

Does the student have any allergies- food or environmental?

Special Considerations for Student

Do you have a third student to register?

Yes

Third Student's Information

Third Student's Name*

First Last

Grade Entering*

Date of Birth

MM slash DD slash YYYY

Preferred Pronouns

Student's Email Address (if applicable)

Student's Cell (if applicable)

Please select the programs/activities your student is interested in*

Nursery on Sunday mornings

Sunday School

Club One Sixteen for kids in grades 1–6 on Wednesday evenings

Tween Programs for grades 4–6

Teen Programs for grades 7–12 (includes Youth Group on Thursday nights and weekend events)

Does the student have any allergies- food or environmental?

Special Considerations for Student

Do you have a fourth student to register?

Yes

Fourth Student's Information

Fourth Student's Name*

First Last

Grade Entering*

Date of Birth

MM slash DD slash YYYY

Preferred Pronouns

Student's Email Address (if applicable)

Student's Cell (if applicable)

Please select the programs/activities your student is interested in*

Nursery on Sunday mornings

Sunday School

Club One Sixteen for kids in grades 1–6 on Wednesday evenings

Tween Programs for grades 4–6

Teen Programs for grades 7–12 (includes Youth Group on Thursday nights and weekend events)

Does the student have any allergies- food or environmental?

Special Considerations for Student

Do you have a fifth student to register?

Yes

Fifth Student's Information

Fifth Student's Name*

First Last

Grade Entering*

Date of Birth

MM slash DD slash YYYY

Preferred Pronouns

Student's Email Address (if applicable)

Student's Cell (if applicable)

Please select the programs/activities your student is interested in*

Nursery on Sunday mornings

Sunday School

Club One Sixteen for kids in grades 1–6 on Wednesday evenings

Tween Programs for grades 4–6

Teen Programs for grades 7–12 (includes Youth Group on Thursday nights and weekend events)

Does the student have any allergies- food or environmental?

Special Considerations for Student

Permission and Authorization

Photo/Video Consent

I give East Liberty Presbyterian Church permission to use photos and/or videos of the student(s) listed on this form and to put the finished photos/videos to any use (newsletter, bulletin boards, website) without limitations or reservation.

Student Contact Consent

I give East Liberty Presbyterian Church permission to contact the registered student(s) regarding the enrolled programs/events on the provided student email and phone number.

Permission to be Driven in the Church Van

I give my child/teen permission to be driven in the church van to offsite events and service projects.

Medical Emergency

In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give the East Liberty Presbyterian Church youth workers the permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary by the youth workers. I give permission for those administering emergency treatment to do so, using those measures deemed necessary. I absolve the youth workers and East Liberty Presbyterian Church from liability in acting on my behalf in this regard, so long as the youth workers are not grossly negligent.

Emergency Contact #1 (non-household member)*

Phone*

How will your children get home? (choose all that apply)

Note: Any child in grade 5 or below must be released to an adult, unless otherwise coordinated with The Rev. Heather Schoenewolf

Bus

Walk

Drive

Picked up by Parent/Guardian/Authorized Adult

Name of Adult authorized to pick up your children

Phone

Name of 2nd Adult authorized to pick up your children

Phone

Name of 3rd Adult authorized to pick up your children

Phone

Parent/Guardian Signature*

First Last

CAPTCHA

ELPC Children and Youth 2024/2025 Program Registration

Student's Information

Second Student's Information

Third Student's Information

Fourth Student's Information

Fifth Student's Information

Permission and Authorization