Generations Children/Youth Registration

Please fill out this form and click submit.

Child's Name

Child's DOB

Gender

Please select one option.

Male Female

Current Grade in School

Parent/legal Guardian's Email

This address will receive a confirmation email

Parent/legal Guardian's Phone

Home Address

Medical Information

Does your child have any allergies?

Please select one option.

No, my child does not have any allergies Yes, but my child does not need an EpiPen. Yes, my child carries an EpiPen

Please list any allergies

Does your child have any Medical Conditions?

Please select one option.

Asthma Seizures Physical Limitations Other No known medical conditions

Please list any medical conditions

Emergency Contact

Contact Person #1

Phone

Contact Person #2

Phone

Contact Person #3

Phone

Staff will notify you by text/phone if an emergency arises. This includes but limited to diaper change/toileting, or sickness

Please select all that apply.

I understand that if my child arrives to class sick, that for the safety of all ministry workers, children and youth, your child will not be allowed to attend.

Please select all that apply.

Do not pick up your child from class without letting the teacher in charge know. Only an adult may pick-up and/or drop-off your child. Your child will only be released to those persons listed as an emergency contact.

Please select all that apply.

Should any unusual circumstances arise, I will contact the Ministry Leader or Generation Coordinator as soon as possible.

Please select all that apply.

I am the parent or legal guardian completing this form. To the best of my ability the information is true and correct. I understand and agree that Crossroads Generations Leaders will be notified of any changes as soon as possible.

Please select all that apply.

Description

Please fill out this form and click submit.

Generations Children/Youth Registration

Description

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