Youth Group 2019-2020
I agree to give permission for my child to fully participate in all activities relating to Youth Group 2019-2020.

In case of emergency, I understand that every effort will be made to contact parent(s), guardian(s), or other relatives listed below. If these contacts cannot be reached, I hereby give the staff and appointed volunteers of First Lutheran Church permission to act on my behalf in seeking emergency treatment for my child/me in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measure deemed necessary. I understand that First Lutheran Church is not responsible for related injuries that may occur during this event.
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What are you registering for? *
Name of Participant #1
Grade Level of Participant #1
Age of Participant #1
Date of Birth of Participant #1
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YYYY
Name of Participant #2
Grade Level of Participant #2
Age of Participant #2
Date of Birth of Participant #2
MM
/
DD
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YYYY
Name of Participant #3
Grade Level of Participant #3
Age of Participant #3
Date of Birth of Participant #3
MM
/
DD
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YYYY
Parents/Guardians
Mailing Address
Home Phone
Parent 1 Cell Phone
Parent 2 Cell Phone
Parent Email
If parent or guardian is not available, please call relative below:  Emergency Contact Name
Emergency Contact Relation to Child
Emergency Contact Phone Number
Any allergies or reactions?
Parent or Guardian Signature
Date
MM
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DD
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YYYY
Please provide a copy of Participant's current Insurance card by email to Melissa at youth@flcbrainerd.com or drop it off to the FLC office/ATTN: Melissa. Thanks!
FLC sends information about upcoming events, concerns, weather related information and other program notes through email and text messages.

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