Child Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Child's Cell Phone

(###)

###

####

Expiry

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please check 1 of the following: *

Please note that "Parent/Guardian 1 Name" MUST be complete on all forms

I have submitted a registration form for a prior child, please use guardian and emergency information below in Section B from the prior form

This is my first registration form or only child (please complete info below in Section B)

Parent/Guardian Name 1 *

First Name

Last Name

Cell Phone *

(###)

###

####

Parent/Guardian Name 2

First Name

Last Name

Cell Phone

(###)

###

####

Emergency Contact if guardians cannot be reached @ numbers above

First Name

Last Name

Emergency Phone Contact

(###)

###

####

Please indicate which programs you would like to register for on WEDNESDAY

Grow With Me (baby play group, 0-6) 9:30 am - 11:30 am

Please indicate which programs you would like to register for on THURSDAY EVENINGS

Family Supper 5:30-6:10

Singing Company 6:15-6:50: ( Kindergarten - Gr 7))

Beginners Band 7:00-7:30: (Grade 1 and up)

Junior Band: 7:00-7:45

Youth Bible Study: 6:115 - 6:50

Youth Band: 7:00 - 8:00 (level 5+)

Youth Worship Team: 8:10 - 9:10 (Grade 6 +)

Please indicate which programs you would like to register for on FRIDAY EVENINGS

Stampede (Junior Youth Group) 6:30 - 8:00 as announced Grades 2-6

Senior Youth Group Grades 7-12

Consent

As the parent/guardian of the above child, I understand and give permission for him/her to participate in all activities and accept the Salvation Army to take and use photos for promotion purposes, realizing that no personal information will be shared.

TRANSPORTATION PERMISSION: I hereby give permission for my child/youth to ride in any vehicle driven by an approved and licensed ADULT chaperone while attending and participating in activities sponsored by Salvation Army St. John's Temple. My child/Youth and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.

CONTACT PERMISSION (AGES 7+): I also hereby give permission for the Director of Youth and Young Adult Ministries to contact my youth via text message/social media regarding church events for senior youth group, Newfoundland & Labrador Divisional Events and other pertinent information for that age group

Parental Consent *

First Name

Last Name

Date *

Tody's Date

MM

DD

YYYY