Geronimo! Student Registration Form

This registration form is for Grace Church's free youth program Geronimo!, which meets on Tuesdays @ 5:30 - 8 pm in the fall and spring. The information below is required to keep your child safe in our programs and will remain confidential. After submitting this form, you will become a contact in our database and will receive all future text communication about our youth programs and events. You may opt out at any time. We look forward to seeing you this year at Geronimo!

Geronimo! is an after-school program for students ages 3-18 at Grace United Methodist Church in Warren on Tuesdays @ 5:30-8 pm that helps youth achieve their full potential and prepares them for a successful future. The Geronimo! program is designed to meet students’ social, emotional, and spiritual needs in a safe learning community. Geronimo! students engage in fun, hands-on, interactive sessions of creative arts, teambuilding, Bible study, and academic tutoring in a small group of peers and supportive adult mentors. All students eat dinner together as a family each night of the program and start the evening with math and literacy games or academic tutoring for students who need help with homework. The program is supported by the community and free to all students.

Grace United Methodist Church

1725 Drexel Ave NW

Warren, Ohio 44485


Child Information

Tip: Please select "PreK" for all preschool-age children.

Contact Information

Emergency Medical Information

Parent/Guardian Contact Information

All emergency contacts listed below will be considered authorized guardians, permitted to check out and pick up this child at the end of the program or in case of emergencies.

Child Permissions

Tip: If your child is featured in a photo or video, can we use it for promotional purposes on our website and social media, or during church services?

Grace Youth Programs Admissions and Participation Policy

Grace Church desires for each youth participating in Awana, Geronimo!, Journey On Summer Camp, and Sunday School to grow spiritually and academically from our programs by having fun, learning, and participating in a safe community. The following rules and information have been created to help ensure this. Please read over this contract carefully before you and your child sign below.

  1. Check In and Dinner. Children are expected to be checked into our programs with a parent signature between the times of 5:45 pm and 6:00 pm. Last calls for food will take place at 6:15. Any child arriving after 6:15 will not receive dinner. When children arrive, they must wait in the Welcome Center until staff releases them for dinner.
  2. Sign Out and Name Tags. Children must be signed out with a parent signature at 8:00 pm. Children may not exit the church unless a parent is visibly with them. Any child who is signed out by a person who is not an authorized caretaker listed on this form will not be permitted to leave.  If a child has been picked up but was not signed out, the Program Director will call home to verify the child’s safety. All name tags must be returned before leaving.
  3. Technology. Cell phones and handheld video games are not permitted in our programs.  Youth are expected to unplug from technology and focus on friendships and learning while at church.  Temporary confiscation will result.
  4. Threats to Child Safety. Our staff members are considered Mandated Reporters by Title IX Ohio Law. If there is any suspicion that the safety of a child is in question for any reason in any setting, we are required by law to follow up with a parent, school guidance counselor, police authorities, or Children Services.
  5. Substances and Safety. Drugs, alcohol, cigarettes, and dangerous items (knives, guns, lighters, etc.) are not allowed in our programs. All bookbags must be left at registration for safety reasons. If a child or driving parent is or is perceived to be under the influence of drugs/alcohol upon arrival, we reserve the right to contact police authorities. In this case, the child will not be allowed to go home with said parent until authorities arrive.
  6. Public Displays of Affection. Youth are expected to keep hands and feet to themselves unless directed otherwise during an activity. Public Displays of Affection between youth of opposite attraction is considered a distraction to learning and spiritual growth and is not permitted on church property during our youth programs.
  7. Child Behavior. Youth are expected to be teachable while attending our programs and be an active participant in the sessions. They should respect community and leaders and engage safely and kindly with one other.  Fighting, arguing, inappropriate language, defiance, or unwillingness to participate in activities is unacceptable behavior.
  8. Parent Behavior. Parents are encouraged to eat dinner with their children and attend our Parent Programs at 6:30 pm in the Welcome Center! Parents are permitted to attend our youth programs only on Family Nights. During Family Nights, parents are not permitted to touch children other than their own unless directed in an activity to do so. We ask that parents please refrain from correcting other children’s behavior and prefer concerns to be communicated to a staff member if there is an issue. Please contact Program Director for questions.


If a child’s behavior violates the rules above, disrupting the learning or safety of our programs:


I hereby understand that measures involving a parent/guardian may be necessary, such as phone calls home, parental supervision during the program, or intervention meetings with the Program Director. If these measures are ineffective in correcting behavior, temporary or permanent suspension from the program may result.

I hereby understand that the names printed in the boxes below serve as signatures to my and my child's agreement to adhere to the rules and policies of the programs they attend, as indicated above, at Grace United Methodist Church.