First Lutheran Sunday School Registration 22-23

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I agree to give permission for my child to fully participate in all activities relating to Sunday School 2022-2023.

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 measures deemed necessary. I understand that First Lutheran Church is not responsible for related injuries that may occur during this event.

Name of Participant *

Grade Level of Participant *

Date of Birth of Participant *

YYYY

Parent 1 *

Parent 2

Mailing Address *

FLC sends information about upcoming events, concerns, weather related information and other program notes through email and text messages.

Home Phone

Parent 1 Cell Phone *

Parent 2 Cell Phone

Parent Email *

Do you give permission for your child's picture to be used on social media, monthly publication (The Messenger), Sunday School projects, bulletins, etc.? *

Yes

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? *

Insurance Company and address *

Insurance Company phone *

ID Number and Group Number *

Policy Holders Name *

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