Youth Programs Registration

This registration form is the universal form for all youth programs here at Grace and St. Stephen’s (please complete a separate registration form for each youth).

We've found that text is the best way to keep youth (and parents) up-to-date on events, deadlines, etc. The Youth Group uses text in two ways

1) youth-to-youth (this thread includes both youth group leaders monitoring messages)

2) a group text that includes parents and youth (at least one parent needs to receive texts, you can opt-in/out below)

If you would like your youth's phone number to be included in these text groups, there's a space below for that information. Please note that we do not share any mobile information with third parties for any reason.

** if no special information regarding your youth's care while in our care is needed, please type NONE in these fields.

Youth Programs Registration Form

Youth First Name

Youth Middle Name

Youth Last Name

Date of Birth (including year)

Grade

Youth Mobile for text communications

Parent/Guardian First & Last Name (1)

Relationship

Address (ST/PO #, City, State & ZIP)

Email address

Phone number

Include me in group texts

Yes

Parent/Guardian First & Last Name (2)

Relationship

Email address

Phone number

Include me in group texts

Yes

1st Emergency Contact Name & Phone #

2nd Emergency Contact Name & Phone #

**List medical conditions we need to know about

**List any medications to be administered while in our care

**List any dietary allergies/needs

**List any other special needs your youth has

**List any other accommodations needed for your youth

Medical Release: In case of emergency, I understand that a reasonable effort will be made to contact me. If I cannot be reached, I hereby give an agent of Grace and St. Stephen’s permission to act on my behalf to seek emergency medical treatment for my youth in the event that such treatment is deemed necessary by the agent. I give permission to any licensed physician selected by this agent to administer such emergency treatment as said physician in his/her judgement deems necessary in the circumstances; and hereby absolve Grace and St. Stephen’s Episcopal Church, its agents and employees from any and all liability resulting from their conformance with these instructions. I agree with the Medical Release.

Yes

Media Release: Photographs and videos may be taken at Grace and St. Stephen’s Episcopal Church to be used for any of these purposes: written promotions; mailings; website, social media and audio/visual presentations. No names will be used. By agreeing to this Media Release, you give permission for your youth’s photo/voice to be used in the above ways. I agree with the Media Release.

Yes

601-631 N TEJON ST COLORADO SPRINGS, CO 80903

Disclaimer: By providing a wireless phone number to Grace and St. Stephen's Episcopal Church, you agree and acknowledge that Grace and St. Stephen's Episcopal Church may send text messages to your wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP”. For more information on how your data will be handled please see our privacy policy below.

Privacy Policy: No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.

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Youth Programs Registration

Youth Programs Registration Form