Youth Registration

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Preschool
Youth

Youth, Jr. & Sr. High Student Registration

Parent/Guardian 1 Name

Parent/Guardian 1 Email:

Parent/Guardian 1 Phone:

Parent/Guardian 2 Name

Parent/Guardian 2 Email:

Parent/Guardian 2 Phone:

Primary Address

City

State

Zip Code

Youth 1 Full Name:

Youth 1 Email

Youth 1 Phone

Youth 1 Birthdate

Youth 1 Baptism Date

Youth 1 Grade Entering

Youth may be contacted via text and/or email about program updates

Yes

Children's Sunday School (3 year olds - 6th Grade)

Junior High Sunday School (7th & 8th Grade)

7th / 8th Grade Confirmation

9th Grade Confirmation

Emerge (9th-12th Grade Youth Group)

Youth 2 Full Name

Youth 2 Email

Youth 2 Phone

Youth 2 Birthdate

Youth 2 Baptism Date

Youth 2 Grade Entering

Youth may be contacted via text and/or email about program updates

Yes

Children's Sunday School (3 year olds - 6th Grade)

Junior High Sunday School (7th & 8th Grade)

7th / 8th Grade Confirmation

9th Grade Confirmation

Emerge (9th-12th Grade Youth Group)

Youth 3 Full Name

Youth 3 Email

Youth 3 Phone

Youth 3 Birthdate

Youth 3 Baptism Date

Youth 3 Grade Entering

Youth may be contacted via text and/or email about program updates

Yes

Children's Sunday School (3 year olds - 6th Grade)

Junior High Sunday School (7th & 8th Grade)

7th / 8th Grade Confirmation

9th Grade Confirmation

Emerge (9th-12th Grade Youth Group)

Youth 4 Full Name

Youth 4 Email

Youth 4 Phone

Youth 4 Birthdate

Youth 4 Baptism Date

Youth 4 Grade Entering

Youth may be contacted via text and/or email about program updates

Yes

Children's Sunday School (3 year olds - 6th Grade)

Junior High Sunday School (7th & 8th Grade)

7th / 8th Grade Confirmation

9th Grade Confirmation

Emerge (9th-12th Grade Youth Group)

Any additional concerns or information that will help us walk with your child

Parent Consent: I hereby consent to single supervision of my child(ren)

I have viewed a copy of “Child and Youth Safety Policy” at Prince of Peace Lutheran Church and am aware that Prince of Peace strives to provide dual supervision for children and youth participating in its classes and other programming.

I am also aware that circumstances may prevent dual supervision from time to time (e.g. unexpected illness of Sunday School teacher or Youth Ministry leader) and that single supervision on such occasions may be permitted with written consent of a parent or guardian of a child or children involved in the activity.

Parent/Guardian Signature

Thank you for registering for Prince of Peace youth programs! Please make sure you also submit your medical form.

More information will be provided soon.

Blessings,

Youth Ministries

Prince of Peace Lutheran Church

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Child & Youth Safety Policy

Youth, Jr. & Sr. High Student Registration

CONTACT US

930 W. Higgins Rd, Schaumburg, IL 60195

P: 847-885-7010

E: church@princeofpeace.net

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