Registration and Media Release for Minors

This form is to be submitted by the parent or guardian of any young person under 18 attending Sunday School, Youth Group or programs at St. James’ Episcopal Church, Fremont. It is intended to help us gather information needed to keep our students safe (food allergies etc) and to provide a media waiver for images taken at church events. This form covers the 2023-24 school year.

From time to time at St. James’ we like to include pictures of our activities in our newsletter or on our website or with the Diocese of California for their publications. We also operate a live stream of our 10:30am service each week.

We are asking that you also share information on allergies or conditions that we may need to know about when planning on site activities, including serving food.

You can complete and submit this form online, or if you would rather, request a paper copy from Jan Scrutton, our Children and Youth Minister. Any questions? Email jan@saintj.com

* Indicates required field

Guardian Name*

Guardian email*

Phone number*

Address*

Child name*
Age*
Date of Birth*
Grade in school*
School*
Allergies/relevant information
Relationship to minor*

You may complete this form for additional children by completing their information below.

Child 2 name
Age
Date of Birth*
Grade in school*
School*
Allergies/relevant information

Child 3 name
Age
Date of Birth*
Grade in school*
School*
Allergies/relevant information

Child 4 name
Age
Date of Birth*
Grade in school*
School*
Allergies/relevant information

(please check) I give permission to St. James' Episcopal Church to take photographs, video, and/or record the voice of the minor(s) named in this form, so that St. James' and the Diocese of California, may use these images and/or audio in print and online publications. I give this consent with the knowledge that St. James' is following the Diocese of California's latest policies regarding digital and social media.

When you select the "submit" button below, it will serve as your electronic signature. This submission is automatically dated when you send. Please contact jan@saintj.com if you have any questions or if you do not want to give permission for photos to be shared.