Firebrand Youth Registration Form

Please complete this form if your child will be active within the Firebrand youth department services, events, trips, etc. If you have multiple children, you can add them all to this one form under the household members.

Please fill this section in with your (the parent/guardian submitting the form) information.

Your name *

Email address *

Phone number

Address *

Household members

Complete this section with the parent/guardian's information + the child(ren)'s information.

To add PARENT/GUARDIAN (who is not listed above) - select "Add Adult"
To add CHILD(REN) - select "Add Child" for each child (if you have multiple)

Does your child have a cell phone? *

MEDICAL INFORMATION

Please note: Your child's information will remain confidential and will only be shared with necessary individuals.

List any known allergies we should be aware of: *

Please list food, medication, environmental, or other allergies. Write “None” if not applicable.

Emergency Medical Consent *

In case of an emergency at church or a church activity, I give permission for designated leaders to provide basic first aid, CPR, call emergency services, and, if needed, give common over-the-counter remedies (Tylenol, aspirin for children, etc.) unless I list restrictions below. I understand this information is confidential and releases the church from liability for unintentional outcomes.

EMERGENCY INFORMATION

An emergency contact person (18+) who is not listed as a parent/guardian.

Emergency Contact - Name *

Emergency Contact - Relationship *

Emergency Contact - Phone *

List any specialized needs your child may have. *

Is there any additional information you would like for us to be aware of?

My child(ren) may be photographed/recorded while attending youth services and events: *

If photographed/recorded, media may be used on various media outlets.

I acknowledge this as my signed signature: *

Please type your full name.

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