Youth Registration 2025-2026
Please fill out this form and click submit.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
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FL
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GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
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NB
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NE
NH
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NS
NT
NU
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OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Date of Birth
*
Health Card Number
*
Emergency Contact Name
*
Emergency Contact Phone
*
Allergies
*
I/we, the parents or guardians named above, authorize Brent Jefkins to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment treatment or procedures for the participant named above (we will contact the parent/guardian in any emergency as soon as possible)
*
I/we named above, undertake and agree to indemnify and hold blameless the Pastor, the Ministry Staff, Covenant church, its Pastors and Church Board from and against any loss, damage or injury suffered by the supervising individuals representing the church
*
Please select one option.
Agree
Disagree
Select Option
Agree
Disagree
I/we, the parents or guardians named above, authorize Brent Jefkins to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment treatment or procedures for the participant named above.
*
Please select one option.
Agree
Disagree
Select Option
Agree
Disagree
We consent to photos to be taken of the student named above and to be used on our social media platforms
*
Please select one option.
Agree
Disagree
Select Option
Agree
Disagree
Parent Signature
*
Submit
Description
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