Youth & Children’s Ministry Medical and Liability Form

Complete this form when requested by a St Paul Children’s or Youth Ministry staff member. One completed form covers all applicable ministry events from September 1, 2026, through August 31, 2027.

Before you begin

Before you begin, have clear photos of the front and back of the participant’s medical insurance card ready to upload. Submit a separate form for each participant.

What to expect

STEP 1

Complete the form

Choose the appropriate ministry year, provide the participant’s information, and upload the insurance-card photos.

STEP 2

Review and sign

Submit the form, then follow the prompts to review and electronically sign the consent document.

STEP 3

Keep your confirmation

After signing, a completed copy will be emailed to you for your records.

Choose Youth or Children's Event(Required)

Participant Information

Because information is unique to individuals, a separate form is required for each participant of the same family.

Student's Name(Required)

First Last Suffix

If necessary, SUFFIX is Jr, Sr, II, III, etc.

Address(Required)

Street Address City State ZIP Code

Date of Birth(Required)

Parent / Guardian Information

Name of Parent / Guardian Completing this Form(Required)

First Last Suffix

This person will be required to electronically sign this form when completed. If necessary, SUFFIX is Jr, Sr, II, III, etc.

Cell Phone of Parent / Guardian Completing this Form(Required)

Work Phone of Parent / Guardian Completing this Form(Required)

Email of Parent / Guardian Completing this Form(Required)

Enter Email Confirm Email

Completed and signed form will be emailed to this address after signed by this person.

Name of Other Parent / Emergency Contact(Required)

First Last Suffix

If necessary, SUFFIX is Jr, Sr, II, III, etc.

Cell Phone of Other Parent / Emergency Contact(Required)

Work Number of Other Parent / Emergency Contact(Required)

Health Insurance / Medical Information

Physician(Required)

First Last

Physician's Phone(Required)

Medical Insurance Company(Required)

Group Number(Required)

Policy Number(Required)

Picture of the Front and Back on Medical Card(Required)

Drop files here or

Max. file size: 1 GB.

List and Allergies, Recent Illnesses or Injuries, Current Medications, or Other Health Information(Required)

If none, type “NONE”

Estimated Date of Last Tetanus Booster(Required)

NOTE: After clicking submit, you will be directed to a signature form for you to securely and safely sign this waiver. Your medical form is not complete until it is electronically signed. Please be patient as we redirect you to that form.

Questions before submitting?

Contact the Children’s or Youth Ministry staff member who requested the form, or contact the church office for assistance.