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Photo of a rainbow over an autumn cornfield at sunset. Taken at the Edmonton Corn Maze October 3, 2025.

Youth Ministry 2026-2027 Registration

Name of Student *

Birthdate

Pronouns

she/her

he/him

they/them

other

Other Pronouns

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Student's Email

if none, leave blank

Student's Mobile Phone

if none, leave blank

Student's Home Phone

if none, leave blank

Student's Home Address

manageMemberFields.fields.AddressLine

common.country

Canada

common.province

No Data

common.area

manageMemberFields.fields.postalCode

manageMemberFields.fields.Building

manageMemberFields.fields.Floor

manageMemberFields.fields.Flat

Grade

For the 2026-27 school year

common.choose

School

Name of Primary Parent or Guardian *

Primary Parent or Guardian Phone Number *

Would you like to include a second parent or guardian?

Yes

Name of a Second Parent or Guardian

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Second Parent or Guardian Phone Number

ــــــــ

Name of an Emergency Contact *

Someone other than a parent or guardian

Emergency Contact Phone Number *

Does this participant have any food, health, or safety concerns that we should know about? *

Yes

Food allergies or health concerns

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Do you give permission for this participant to take part in activities associated with Robertson-Wesley United Church? *

Yes

Do you give permission for this participant to be photographed for the purpose of promoting the programs of Robertson-Wesley United Church, including on the congregation's website? *

Yes

Parent/Guardian's Signature *common.clear

Date Signed *

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