Youth Group Teen Information (2024):

PLEASE ENTER TEEN INFORMATION FIRST

Your name *

Email address *

Phone number *

Teen Address *

Teen City *

Teen State *

Teen Postal Code *

Birthdate *

Gender *

School: *

Grade *

Teen T-Shirt:

Teen Sweatshirt Size:

Teen Medical Information:

Medical conditions (Please list any known medical conditions, allergies, and medications currently being taken: (If none, type “none”) *

Teen’s Physician’s Name: *

Physician’s Phone: *

My child is insured under the following primary health care plan: (Insurance Company) *

Plan Name: *

Insurance Group number/name: *

Subscriber number/name: *

Father's Information:

Father's Name

Phone number *

Phone number

Mother's Information:

Mother's Name

Phone number *

Phone number

Alternate Emergency Contact:

Alternate Emergency Contact Name: *

Phone number *

Youth Group Release and Authorization:

I agree to the following: *

I (We) do hereby release and discharge the Church of Christ at Trenton Crossing, Chris Middleton, all other attending adults, and authorized representatives and staff from liabilities for any personal injury or damage to property that may occur on the premises or as a result of activities. I also authorize medical treatment if needed and release the Church of Christ at Trenton Crossing authorized representatives and staff from any liability connected with medical treatment.

I agree to the following: *

In an effort to enjoy the ministry activities during the 2024 year while limiting the spread of COVID-19, we are asking you to carefully read these agreements.

By marking ‘I agree’ you are agreeing to let your child or (“my student”) participate, knowing the risks and expectations set by the government, the CDC, COCTC church leadership, and the TCYG leadership team. If at any point, after filling out this initial agreement, you choose to NOT agree contact, Chris Middleton.

I agree to the following: *

I agree to closely monitor my child’s health and that I am responsible to advise COCTC of my child’s health conditions.

I agree to the following: *

Photo Release Form for Minors (if under 18):
COCTC & TCYG has my permission to publicly use my or my child’s photograph to promote the Church of Christ at Trenton Crossing and Trenton Crossing Youth Group. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

I agree to the following: *

By signing below, I give permission to my teen to attend TCYG events this year. I hereby and agree to hold TCCOC and its representatives, employees, agents, elders, and members harmless from and waive on behalf of myself, our heirs, and any personal representatives any and all causes of action, claims, demands, costs, expenses, including without limitation legal expenses, and compensation for damages or loss to my student and/or myself and/or property that may otherwise arise in any way in connection with any activities of the TCYG. I hereby release COCTC and the TCYG from any and all liability for the unintentional exposure of my student to, or harm due to the Coronavirus (COVID-19), or harm caused thereby.

Parent or Guardian Signature: *

By typing your name below, you accept this as your electronic signature.

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