Redeemer Youth Registration and Permission Form
This authorization is valid from September 1, 2021 - August 31, 2022
Redeemer Lutheran Church, 1545 Chain Bridge Rd, McLean, VA 22101
Contact us at 703-356-3346
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Email *
Youth Name *
Grade (please check only one) *
Birth Date *
MM
/
DD
/
YYYY
Parent Name(s) *
Address *
Phone Number(s) *
Allergies *
If answered yes to allergies, please let us know what type:
Dietary Restrictions
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Emergency Contact (name, relationship, phone) *
If not the same as above, Emergency Contact (name, relationship, phone)
Permission to participate in youth activities: I hereby grant permission for my child to participate in Redeemer Youth Ministry activities under the supervision of adult chaperones. I understand my child may engage in physical activities with risk of injury. *
Permission for Emergency Medical Treatment: In the event that I cannot give authorization in person, I hereby authorize an adult chaperone from Redeemer Lutheran Church to seek emergency medical treatment for my child. *
Permission for Photography: I give permission for my child's picture to be placed on Redeemer's website &  on social media. *
Permission to text Reminders: I give permission to receive texts from Redeemer Lutheran Church. *
What number should we text? *
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