First Lutheran Church Youth Registration Form 2020-2021

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CHILD´S INFORMATION

CHILD'S FIRST NAME *

CHILD'S LAST NAME *

Goes by

Age *

Birthdate (MM / DD / YYYY) *

Grade *

School *

Baptismal Birthdate (not required)

Primary Phone *

Address *

City / Zip Code *

PARENT-GUARDIAN´S INFORMATION

1st Parent/Guardian Name *

1st Parent/Guardian Cell Number *

1st Parent/Guardian Email *

2nd Parent/Guardian Name

2nd Parent/Guardian Cell Number

2nd Parent/Guardian Email

MIDDLE & HIGH SCHOOLERS ONLY (next 2 questions)

Youth´s Cell Number

Youth´s Email

HEALTH INFORMATION

Allergies, Reactions, Asthma, Diabetes, Other?

Adaptive equipment, glasses, contacts, hearing aids, etc.?

Other helpful health-related information?

If your child will be taking any medication while at a FLC program, be sure staff are informed.

IN CASE OF EMERGENCY -- MUST list two people other than parent/guardian listed above!

Name #1 *

Relationship #1 *

Phone number #1 *

Name #2 *

Relationship #2 *

Phone number #2 *

PERMISSION

Permission

I give permission for my child to participate in all First Lutheran Church activities as planned, noted on the calendar and included in promotional materials.

I authorize First Lutheran Church to take such action is deemed necessary for the care, welfare and health of my child including giving consent for medical treatment. I will not hold First Lutheran Church, staff or volunteers responsible for accidents, claims and damages arising therefrom.

I also give First Lutheran Church permission to use any photography/video of my child taken in conjunction with a First Lutheran Church program in future promotions.

ELECTRONIC SIGNATURE

By clicking the "I accept" box below, you are signing this youth registration electronically. You agree your electronic signature is the legal equivalent of your manual signature on this registration.

I accept

I do not accept and will bring a signed, printed copy of the First Lutheran Church Youth Registration to the church as soon as possible.

Your name *

TODAY'S DATE (MM / DD / YYYY) *

Thank you for taking the time to complete this youth registration form! We look forward to an exciting year of ministry with your child!

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