Youth Ministry

Welcome to Reflectors Youth Group!

As followers of Christ, we need to reflect His love for us onto others. As you can see in the logo, the reflection isn’t the word “reflectors”, it’s JESUS! At Reflectors Youth Group, kids are encouraged to show Christ’s love to others through their actions and words.

Reflectors meets on Sunday nights September 8, 2024-May 4, 2025. All 6th-12th grade students are welcome to join us for group games and snacks, then the students move to small groups for Bible study. Scroll down to complete the permission slip which covers all outing/events for the year.

Winter Retreat 2025

Register Your Student(s) Now

The consent given via this form gives the student named on this form permission to participate in Leighton Church Youth Group activities where he/she is driven by someone other than his/her parent/guardian. This form is effective from September 8, 2024-September 6, 2025. In the event of an emergency affecting the health or welfare of this participant, the directors, leaders or adult chaperones have permission to administer first aid and/or transport the individual to the nearest doctor or medical center for further medical attention, as deemed necessary. The individual action in response to the emergency will be held blameless. Any medical expenses occurring will be borne by the participant, or parent/guardian of the participant. The parent/guardian giving consent hereby releases and discharges Leighton Church and all of its directors, leaders, and adult chaperones acting officially from any and all claims, demands, actions, or causes of action on account of any injury sustained by the participant. If any conduct of the participant warrants them to be excused from an event, the undersigned assumes all responsibility for disciplinary action and picking up said participant upon being notified by the director, leader, or adult chaperone. Should it be necessary for the participant to return home due to any reason, the undersigned hereby assumes all transportation costs. Furthermore, I/we give Leighton Church permission to photograph my student while he/she participates in any activity and will allow these photos to be used for promotional purposes (including the church website, Facebook, Twitter, Instagram, and/or YouTube)

Student's Name *

First

Last

Student's Birth Date (month/date/year) *

Name of School *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Student Email

Student Cell Phone

Student Health Insurance Carrier *

Last Tetanus Injection

Current Medications

Allergies

Doctor Name

Doctor Phone

Mother/Female Guardian Name *

First

Last

Father/Male Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Secondary Email

Mother/Female Guardian Phone

Father/Male Guardian Phone

Emergency Contact Number *

Special Medical, Physical, and/or Behavioral Instructions

Name(s) of Person(s) Who May Pick Up Student

Parental Consent for Child *

Yes, I provide consent.
No, I do not provide consent.

Preferred Form of Communication *

Name of Person Completing Form *

First

Last