Junior Youth Registration Form 2026-2027

Please fill out this form and click submit.

Student

Student Name

Date of Birth

Grade

Parents

Parent Name

Relationship

Address

This address will receive a confirmation email

Phone

Emergency Contact - If Parent Can't Be Reached

Name

Relationship

Phone

Medical Information

Does your child have any allergies?

Please select all that apply.

Yes No

If yes, please explain

Any other medical information we should know about

Permission to Participate

I give permission for my child to participate in South Shore Church Youth Activities

Please select all that apply.

Behavioral Expectations

I understand that students are expected to: Treat others with respect. Follow Leader instructions. Use appropriate language. Respect church property. Participate safely.

Please select all that apply.

Yes No

Photography and Video Release

Photos and videos may occasionally be used for:

Church Website

Please select all that apply.

Yes No

Promotional Material

Please select all that apply.

Yes No

Church Presentations

Please select all that apply.

Yes No

Church Facebook Page

Please select all that apply.

Yes No

Communication Permission

I would like to receive updates by:

Please select one option.

Email Text Message

Permission for Special Off-site event on September 16 - Permission to go to the community centre/ball diamond across the street Address: 1875 ON-654, Callander, ON P0H 1H0 - to play slip and slide baseball

Please select all that apply.

Yes No

Permission for Special Off-site event on October 7 - Permission to go to the community centre/ball diamond across the street Address: 1875 ON-654, Callander, ON P0H 1H0 - to play manhunt and sardines

Please select all that apply.

Yes No

Permission for Special Off-site event on December 9th - Permission to go walk down the shoulder of highway 654 west and Tillicum Bay Road to do random acts of kindness for neighbors. - Youth will travel in groups of 4 or more with at least 2 leaders

Please select all that apply.

yes No

Parent Consent

Date

Electronic Signature

*By entering my name in the above box, I am providing my digital signature on this form

Location Signed at:

Description

Please fill out this form and click submit.

Junior Youth Registration Form 2026-2027

Description

Please Fix the Following