Resurrection Sunday School Registration 2022/23

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*If registering more than one child, please submit a form for each child individually!

Email *

Child’s Name *

Child’s Age *

Which grade is your child entering in the fall? *

Emergency Contact (person other than a parent) *

Relationship to child: *

Telephone Number: *

Parents/Guardians Name: *

Address: *

City: *

Zip: *

Father: Phone-Home: *

Father: Phone-Cell: *

Mother: Phone-Home: *

Mother: Phone-Cell: *

Does your child have any medical conditions (including allergies) or concerns that could impact their health/safety while under the supervision of Lutheran Church of the Resurrection? Please list below: *

Does your child carry an EPI Pen? *

Yes

*If so, your child must carry their EPI Pen to Sunday School. Please affirm the following: *

Yes, I agree to this requirement.

No, my child does not require an EPI Pen.

Please check all that apply: *

Child has asthma

Child has had anaphylaxis

Child may carry medicine

Child may give him/herself medicine

Child has a moderate-severe reaction to insect stings

None

Other:

Required

I, the parent or legal guardian of the aforementioned child, a minor, hereby authorize Lutheran Church of the Resurrection personnel to seek medical attention that may be necessary in an emergency situation. *

I affirm and give my permission

My child has my permission to attend this church event/activity. I understand that he/she will be subject to all rules, regulations and supervision of the chaperones. I affirm that I have disclosed any medical information necessary to ensure the safety of my child while at this event/activity. I affirm that I have disclosed the need for, and provided, any medication that my child may need while under the care of Lutheran Church of the Resurrection. *

I affirm and give my permission

I understand that there are certain risks inherent in the participation in physical activity, and I knowingly and voluntarily assume the risk of injury, illness or other harm due to any act, event or omission related to my child’s participation. *

I affirm and give my permission

I give my consent for photographs and video images of my child to be used on the Resurrection website, classroom videos/posters, church services and/or church publications. *

I affirm and give my permission.

I do not consent. Please do not use any photographs and video images of my child.

PARENT/GUARDIAN SIGNATURE - by typing your name in the signature box, you attest to all the above information* *

A copy of your responses will be emailed to the address you provided.

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