Trinity Lutheran Church - EDGE High School Youth Ministry Medical Release/Permission and Registration Form 2023-24

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Please fill out this form completely to register for the upcoming year of EDGE Youth Ministry! As emergencies are never predictable this form is required to be filled out for participation in Trinity Youth Ministry Programs. One form per youth please.

Any questions? Contact Marie at mray@trinitynorthbranch.org

*Email will be the primary way we communicate with families throughout the year.

Email *

Parent/Guardian #1 Name *

Parent Guardian #1 Home Address (street, city, zip code) *

Parent/Guardian #1 Cell Phone Number *

Parent/Guardian #1 Home Phone Number (if applicable) *

Parent/Guardian #2 Name *

Parent Guardian #2 Home Address (street, city, zip code) *

Parent/Guardian #2 Cell Phone Number *

Parent/Guardian #2 Home Phone Number *

Parent/Guardian #2 Email Address *

Youth Name *

Youth Date of Birth *

YYYY

Baptism Date *

YYYY

First Communion Date *

YYYY

Youth Grade for 2023-24 School Year *

School Youth Attends *

Youth Cell Phone

Permission to text youth *

Yes

Youth Email

Permission to email youth *

Yes

Church you attend (All are welcome!) *

Emergency contact #1 if parent cannot be reached. Please give name, relation, and phone number *

Emergency contact #2 if parent cannot be reached. Please give name, relation, and phone number
*

Special Medical Concerns, Medications being taken, Allergies (especially to food or medications) (If none, simply type "none") *

Family Doctor *

Family Doctor Phone *

Family Dentist *

Family Dentist Phone *

Medical Insurance Company *

Policy/ID# for medical insurance: *

Parent Involvement: I am interested in serving (Please consider choosing one because as a parent you play a huge role in your child’s faith life) Adults must be active members/visitors for a minimum of 6 months to volunteer with Trinity youth programs and a yearly background check is required.

EDGE Weekly Leader/Helper

EDGE Special Event Driver/Chaperone

EDGE Mission Trip/Retreat Adult Leader

Not interested or available at this time

Required

Authorization for Participation of Minors: I give permission for my child to participate in youth and family ministry activities sponsored by Trinity Lutheran Church, including travel to and from locations, for the period of September 1, 2023, to August 31, 2024.

I/We authorize the participation and travel for the above named minor

Required

Medical Release: I, the parent/guardian of my child authorize a representative of Trinity Lutheran Church to take such action as deemed necessary for the care, welfare and health of my child including the giving and consent of medical treatment when parental/guardian consent shall be unavailable or when circumstances require immediate medical decision.

I/We have read and agree to the medical release.

Required

Media Release: I give permission for Trinity Lutheran Church to use, publish, or disclose in newsletter, brochures, posters, website, social media, or other media-related vehicles, any photographs, videos, audios, or other material in which my child may have appeared, spoken or written or otherwise been represented. No names shall be attached to any media used.

I/We have read and agree to the media release.

Required

Participation Release:

I acknowledge that participation in Trinity Lutheran Church youth and family activities involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in Trinity Lutheran Church youth and family activities, the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by Trinity Lutheran Church or its agents, employees, volunteers, or any other representatives. Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless Trinity Lutheran Church and its employees and volunteers for any injury arising directly or indirectly out of Trinity Lutheran Church youth and family activities or transportation to and from the activity, whether such injury arises out of the negligence of Trinity Lutheran Church, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and Trinity Lutheran Church cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize and participate in the services of Trinity Lutheran Church and enter Trinity Lutheran Church’s premises.

I/We have read and agree to the participation release.

Required

Parent/Guardian Signature *

Date of Parent/Guardian Signature *

YYYY

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

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