CTK Luther League Permission Form Fall 2021-Spring 2022

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This form is for any 6th-12th grade youth participating in Christ the King Lutheran Church Luther League (youth group) events. If you have any questions, please contact Deacon Ben Remmert at benremmert@ctkelc.org.

Email *

Full Name: *

Current Grade *

School Attending

Birth Date: *

T-Shirt Size:

Small

Medium

Large

XXL

Other:

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Mailing Address *

Student's Cell Number: *

Students Email: *

Parents Cell Phone *

Parent(s) Email *

Emergency Contact and Phone Number: *

Those Authorized for Pick Up *

Medical Insurance Company and Policy Number

Does your youth have any Medical Conditions/Allergies we should be aware of? *

Does your youth have any behavior/learning concerns?

Participants Covenant- I will participate fully in all CTK events and activities, honor time commitments, and respect property, and the rights of my peers and adults leaders. I understand that failure to abide by this covenant will result in consequences; one of which includes being sent home immediately at my own expense. *

Yes

I, the individual or parent/guardian of youth, authorize a representative from Christ the King Lutheran Church to take such action as deemed necessary for the care, welfare, and health of myself/youth including giving and consent of medical treatment. I understand that I am responsible for any charges that may be incurred. *

Yes

I, the individual or parent/guardian of youth, give permission to use, publish, or disclose newsletters, and websites any photographs, videos, audios, and any other material which I or my youth may have appeared, spoken, written, or otherwise represented. *

Yes

By participating in programs, services, and activities of Christ the King Lutheran Church, you agree to the following: On behalf of yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Christ the King Lutheran Church, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities . You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such program, service or activity. *

Yes

Send me a copy of my responses.

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