Redeemer Youth - Faith Formation, Confirmation and High School Registration and Permission Form
This authorization is valid from September 1, 2023 - August 31, 2024
Redeemer Lutheran Church, 1545 Chain Bridge Rd, McLean, VA 22101
Contact us at 703-356-3346
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Email *
Youth Name *
Grade for 2023-24 School Year (please check only one) *
Birth Date *
MM
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DD
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Parent Name(s) *
Address *
Phone Number(s) *
Allergies *
List all allergies and if an EpiPen is prescribed for emergencies
Dietary Restrictions *
Additional Emergency Contact (include name, relationship and phone number) *
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 and on social media. *
Permission for Text Reminders: I give permission to receive texts from Redeemer Lutheran Church. *
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