CYFM Registration 2024-2025
Please fill out this form and click submit.
Adult Name/s
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Adult Email/s
*
Phone
*
Email or phone for older youth (will always be contacted with a CC to parent or other adult)
Address
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Best Sunday morning emergency contact
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Infant, Child or Youth #1 Information. Please provide: Name, any medical issues or allergies, special instructions, and anything else we should know.
Birthday and current age
*
Grade
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Infant, Child or Youth #2 Information. Please provide: Name, birthday, grade, any medical issues or allergies, special instructions, and anything else we should know.
Birthday and current age
Grade
Infant, Child or Youth #3 Information. Please provide: Name, birthday, grade, any medical issues or allergies, special instructions, and anything else we should know.
Birthday and current age
Grade
Infant, Child or Youth #4 Information. Please provide: Name, birthday, grade, any medical issues or allergies, special instructions, and anything else we should know.
Birthday and current age
Grade
Infant, Child or Youth #5 Information. Please provide: Name, birthday, grade, any medical issues or allergies, special instructions, and anything else we should know.
Birthday and current age
Grade
The undersigned parent or legal guardian of the minor child/ren above does hereby grant permission for the said child/ren to engage in the various activities sponsored by Saint Philip’s in the Hills Episcopal Church.
*
Please select one option.
Yes
No
I hereby grant to Saint Philip’s in the Hills Episcopal Church the right to photograph (during the course of Church-sponsored activities) my dependent child/ren above and to use the photo and/or other digital reproduction of said child or other reproduction of their physical likeness for publication purposes, whether electronic, print, digital or electronic publishing via the Internet. Children WILL NOT be identified by name without specific written permission from parents. I certify that I am a custodial parent and have the aforementioned rights to assign.
*
Please select one option.
Yes
No
Select Option
Yes
No
I/we, the undersigned parent(s)/guardian(s) of the minor child/ren do authorize Saint Philip’s in the Hills Episcopal Church, its designated representatives, and other official personnel connected with Church-sponsored activities, to consent to any medical treatment which may be deemed advisable during the sponsored activity. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of aforesaid agent to give specific consent to any and all such aforesaid diagnosis, treatment or hospital care which may be deemed advisable in consultation with licensed medical personnel in the event of an emergency. The authorizing person further understands and agrees: that if medication is to be given to the registered minor by Saint Philip’s personnel, that they are not legally or financially liable for administering or for the results of administering medication; if medication is to be given, parent/guardian must make arrangements with the Saint Philip’s personnel; that in case of accident, Saint Philip’s in the Hills, other participating organizations and their designated leaders assumes no financial responsibility beyond the secondary insurance coverage. I hereby give my authorization for my child to be subject to the supervision of the Saint Philip’s staff and designees.
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Please select one option.
Yes
No
Select Option
Yes
No
By typing my name I sign the above releases.
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We plan to attend Fall Orientation on Sunday, August 18, 11:15am-1:00pm
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Please select one option.
Yes
No
Select Option
Yes
No
Please send me information about the Saint Nicholas Youth Choir Retreat on Saturday, August 24.
Please select all that apply.
Yes
No
We are interested in attending the CYFM Family Retreat on Nov 11 Weekend
Please select one option.
Yes
No
Will respond later
Select Option
Yes
No
Will respond later
We would like to participate in the Christmas Pageant, please contact us
Please select one option.
Yes
No
Select Option
Yes
No
We would like to have a follow up conversation about
Please select one option.
Church Membership
Baptism of Children or Adults
Confirmation of Youth or Adults
Giving or other Church Leadership
Other
Select Option
Church Membership
Baptism of Children or Adults
Confirmation of Youth or Adults
Giving or other Church Leadership
Other
Additional Comments about the above dates and questions
Submit
Description
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