Youth Events Registration Form

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So, we can look after students in the best possible way we need info! We commit to keeping this information private. We will only use it to ensure the safety and well being of students while involved with St. Marks...

Student's Name: *

Which Event/s will the student be attending? *

Confirmation

C.H.A.O.S (Fortnightly Fridays @ 7pm - 9pm)

Other:

Required

Students School:

Student's School Year:

Student's Date of Birth: *

YYYY

Student's Gender: *

Female

Male

Other:

Student's Email:

Student's Mobile:

Full Address:

Parents / Guardians Name/s: *

Parent Mobile Phone/s: *

Parent Email/s: *

Emergency Contact Name and Phone No.: *

Medical Conditions Or Needs: *

Food Allergies *

Other Important Things we Should Know:

Parental/Guardian Consent *

I consent to this information being stored by St. Mark's Church. It will be used only for Youth Ministry in accordance with the LCAQD Privacy Policy

I agree that in the event of a medical emergency where I cannot be contacted that leaders will arrange the best possible medical care. I agree to pay in full for all medical costs involved. I will not hold St. Marks Church or its agents for any loss or injury ocurred. (REQRD)

I consent to the use of photos of my student for promotional purposes within St. Mark's Church (OPTIONAL)

I contest to my student being transported by a fully licensed youth leader (only in case of a medical incident or at leader's retreat) (OPTIONAL)

Required

Parent Signature (Print name in Caps) *

Date of Signature *

YYYY

Student Commitment *

I will respect people and help everyone have a good, safe, and fun time.

If I am disrespectful or make people feel unsafe then I may not be allowed to participate in activities, my parents may be phoned or asked to pick me up.

I understand that St. Mark's Youth is completely drug and alcohol free

Required

Student Signature (Print Name in Caps) *

Date of Signature *

YYYY

St. Mark’s Lutheran Church gathers and stores the following information: names, addresses, phone numbers, email addresses. This information is stored only for the purpose of communication with and care for our church community. No personal details are given out to anyone not in this contact list. Details will not be published or made available anywhere else without prior consent. If you have any questions about our privacy policy or wish to be removed from the list, please contact St. Mark’s church office.

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