Last Name of your child(ren)
Enter primary contact phone number.

About Your Child(ren)

Choose all which apply.
Please note any allergies to food or medication, and any medical conditions which might impact care and participation in activities.
If applicable.
If applicable.
Please note any allergies to food or medication, and any medical conditions which might impact care and participation in activities.
If applicable.
If applicable.
Please note any allergies to food or medication, and any medical conditions which might impact care and participation in activities.
If applicable.
If applicable.
Please note any allergies to food or medication, and any medical conditions which might impact care and participation in activities.
If applicable.
If applicable.
(NOTE: If no other names are provided, children will only be released to known family members).
Name, contact info of non-family-member contact.
  • In the event of an extreme emergency, if parents cannot be reached, I understand that my child will be taken to Evanston Hospital for appropriate treatment at my expense.
  • I understand that there are certain risks of physical injury or illness associated with activities at First Presbyterian Church. I expressly assume these risks for my child and me, whether such risks are known or unknown to me at this time. I release First Presbyterian Church of Evanston, including its affiliated directors, volunteers, employees, contractors and agents, from any claim that I or my children may have now or in the future against them for any physical and personal injury, illness, or death due to participation in Sunday morning worship, classes, and activities. This release of liability shall cover (without limitation) all claims for negligence and breach of fiduciary duty asserted by my child or any person made on their behalf.
  • I hereby give my consent for walking field trips to the beach or nearby parks. (Youth Program—I hereby give my consent for my youth(s) to be driven for programmed activities.)
Let us know if we can use images of your child(ren) to publicize FPCE events and in church communications.
This must be signed for child(ren) to participate in FPCE activities, including Sunday School.
Would your child(ren)/student(s) be interested in reading scripture in a Sunday morning service?

Adult Volunteer Opportunities

Let us know if you would like to volunteer for one or more of the opportunities below.
Select all that apply.

If your student is in 6th grade or higher please continue to fill in the following information.

List student's name, followed by school name.
Please list significant health history (such as food and drug allergies, medical restrictions, asthma, behavior issues, etc.):
Medication taken on a regular basis (student name/medication/directions).
Usually found on back of insurance card.
I, the undersigned, give my daughter/son permission to participate in activities that will be hosted by First Presbyterian Church of Evanston Youth Ministry.
I have also read the Covenant of Conduct below with my child and agree to the terms.
I hereby give permission to First Presbyterian Church Youth Staff to provide over the counter medication such as antacid, ibuprofen, acetaminophen, and allergy medicine. Furthermore, I hereby give permission for the Youth Staff to provide routine, non-surgical medical care for my child as named in this form (all exceptions are to be listed below). This applies to any church-sponsored activity my child attends on or off the First Presbyterian Church of Evanston’s premises. In the event I cannot be reached in an emergency, I hereby give permission to the nurse or physician selected by the youth staff to hospitalize, secure proper treatment for and to order injection, anesthesia, or surgery for my child as named in this form except as noted below:

During youth ministry meetings, events, retreats or trips that I choose to attend I agree to not participate in the use of drugs, alcohol, or profanity during this event. I agree to be present at all group activities on time and in an orderly fashion. I agree to refrain from any sexual activity or inappropriate displays of affection during this event. I agree to treat all persons, regardless of race, gender, religion and culture, with respect and consideration. I will refrain from the illegal purchase or use of tobacco products. I will respect the facilities we are using and realize should damage occur because of my negligence I am responsible. I will not use cell phones, electronic game equipment, portable speakers, iPods, or other items that may distract me from participation. (Any equipment brought will be in a leader’s possession at the risk of damage and loss during the event in question.) I will not bring or use any weapons, firearms, pornographic materials, or any other inappropriate items. I will not abuse others including: Physically (strike, shake, or slap), verbally (humiliation, degrade, or threaten), sexually (including inappropriate touching, exposure and comments), and emotionally (harsh sarcasm, name calling, gossiping, etc.). I will portray a positive role model for others by maintaining an attitude of respect, patience, integrity, courtesy, and maturity. I have read the Covenant of Conduct and fully agree with the conditions. I understand that I will be excused from participating in the event in question or sent home at the expense of my parents if I violate any conditions of this covenant. There is a 3 strikes and out policy which is adopted from Matt.18: 15-17. [1st Offense (verbal warning) 2nd Offense (parents are called) 3rd Offense (student will be asked to leave the activity)]
By signing, you acknowledge your understanding and agreement to comply with FPCE policy.
Required for those students in 6th grade or higher. By signing, you acknowledge your understanding and agreement to comply with FPCE policy.
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