Next Gen Registration Form 2026-2027

Join the fun! Next Gen Ministries Start Wednesday, September 9 @6pm!

Embrace Life Babysitting (0-PreK)
Ignite (grades K-2)
Nexus (grades 3-5)
Catalyst (grades 6-12)

Parent/Guardian Information

Name

This address will receive a confirmation email

Phone

Address

Relationship to the child(ren).

Child #1 Information

Name

Birthdate

Age

Grade

Medical or other information we need to know. (Please include any food allergies.)

Child #2 Information

Name

Birthdate

Age

Grade

Medical or other information we need to know. (Please include any food allergies.)

Child #3 Information

Name

Birthdate

Age

Grade

Medical or other information we should know. (Please include any food allergies.)

Child #4 Information

Name

Birthdate

Age

Grade

Medical or other information we should know. (Please include any food allergies.)

Child #5 Information

Name

Birthdate

Age

Grade

Medical or other information we should know. (Please include any food allergies.)

Emergency Information

Emergency Contacts (Other than listed above.) Names & Phone numbers

Physician Name:

Physician Phone Number:

Emergency Authorization

I hereby authorize First United Presbyterian church leaders/staff to act on my behalf when I cannot be contacted, IN CASE OF AN EMERGENCY, resulting in the need of medical attention for my son’s/daughter’s named above. I also agree to not hold First United Presbyterian Church, Moline, IL liable for any incident that may result from participation in any of our activities or events, as a result, of my child's participation in its activities. Furthermore, I agree to reimburse First United Presbyterian Church, Moline, IL for any medical expenses.

Electronic Signature*

*By entering my name above, I am providing my digital signature for Emergency Authorization on this form.

Other Information

Dismissal Information: Who may pick up your child(ren) on Wednesday nights each week?

Permission of Photography

May we have permission to photograph your child(ren)?

Yes No

May we have permission to use your child(ren)'s photograph without a name attached on promotional materials, including but not limited to, social media or other electronic communication?

Yes No

I further understand that if I do not wish for my child(ren) to be photographed, it is my responsibility to notify the Next Gen Coordinator.

Electronic Signature*

*By entering my name above, I am providing my digital signature for Permission of Photography on this form.

Consent to Receive Text Messages

I consent to receive pertinent ministry related messages such as cancellations or special events from First Pres Moline.

Yes No

I consent to my child receiving text messages from Next Gen volunteers (6th-12th grade only)

Yes No N/A

Description

Please fill out this form and click submit.

Next Gen Registration Form 2026-2027

Description

Please Fix the Following