Kids & Youth Registration

Father's First Name

Father's Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Mother's First Name

Mother's Last Name

Address (if different)

Apartment, suite, etc.

City

State

Zip/Postal Code

Please list the name of the nearest relative/neighbor to be contacted in case of an emergency if you cannot be located:

First & Last Name

Phone Number

Relation

I give my permission for the above named child to be in pictures taken related to Sunday or midweek activities sponsored by Aldersgate Church used for historical and promotional purposes, and that my be placed on the church's website, Facebook & Instagram pages.

Signature

Phone Number

Adults authorized to pick up my child(ren):

First & Last Name

Phone Number

Relationship

People who may NOT pick up my child(ren) (if applicable):

Name

Kids & Youth Information

Name

Date of Birth

Gender

Age

Grade (Fall 2026)