Youth Form - First Presbyterian Church of Albany

Youth Info

Email

Name

First

Last

Nickname/name preferred

Pronoun preference

She/her/hers
He/him/his
They/them/theirs
Other

Please tell us your pronoun preference

Cell Phone

Home Phone

Date of Birth

Place of Birth

School year

2023 to 2024
2024 to 2025
2025 to 2026

Select grade in school 2023–2024 (if applicable)

Photo Authorization

I give my permission for First Presby to use the photos of my child for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, social media, and web content.

Yes
No

Parent/Guardian Info

Parent/Guardian Name

First

Last

Email

Relationship to Child

Home Phone

Cell Phone

Work Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you need to add additional parent/guardian fields?

No
Yes

Additional Parent/Guardian Info

Additional information if parents are separated or divorced

Parent/Guardian Name

First

Last

Email

Relationship to Child

Home Phone

Cell Phone

Work Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Who has primary custody?

First

Last

Do you need even more to add additional parent/guardian fields?

No
Yes

Additional Parent/Guardian Info x2

Parent/Guardian Name

First

Last

Email

Relationship to Child

Home Phone

Cell Phone

Work Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Who has primary custody?

First

Last

Other

When church school is over at 10:15, we need to know if your child will be picked up from class or allowed to leave on his/her own. Please select the appropriate option and make sure your child is aware of this decision:

Sibling's name

First

Last

Does your child have any allergies, food or otherwise?

No
Yes

Please list and tell us what to do in case of an allergic reaction:

Any other information which would be good for us to know about your child as she or he enters this new year of church school?