Lighthouse Youth Registration

Welcome to Lighthouse Youth!

We’re so excited for your student to join us this year. Lighthouse Youth is a place where students can belong, have fun, build friendships, and grow in their faith. Whether they’re exploring who Jesus is or looking to deepen their relationship with Him, there is a place here for them.

Please fill out the registration form below so we can keep you updated on upcoming events, gatherings, and special opportunities. This information helps us care for your student well and keep our programs safe and organized.

We can’t wait to journey with your family this year!

Your name *

Email address *

Parent / Guardian Information

First and Last Name *

Phone number *

Address

Email Address *

Student Information

Phone number *

Address

Birthdate *

Gender

Grade *

Household members

Emergency Contact *

First Name
Last Name
Relationship to child
Phone number

Medical & Allergy Information

Does your student(s) have any known allergies (food, medication, environmental etc)? *

Does your student(s) have any medical conditions we should be aware of? *

Is your student(s) allowed to receive over the counter first aid if needed (e.g. band aids, antiseptic wipes etc.)? *

Pickup & Dismissal Information

Who is authorized to pick up your student(s)? (Include full names and phone numbers of ALL individuals allowed to pick up your child) *

Do you give your child permission to walk home? *

In case of emergency and you cannot be reached, do you give permission for the emergency contact listed about to pick up your student(s)? *

Photo & Video Release

Lighthouse Community Church occasionally takes photos/videos during services and events for church communications and social media.

Do you give permission for your student(s) to be photographed/recorded *

Parent / Guardian Consent & Signature

By signing below, I affirm that the information provided is accurate. I give Lighthouse Community Church permission to care for my student(s) in alignment with the information above and to contact me in case of emergency.

By typing your name here you are submitting an electronic signature agreeing to the above *

Date *