2019-2020 Emergency Contact Information and Parental Agreement
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Student's Last Name *
Student's First Name *
Grade Level for 2019-2020 School Year *
Student's Birthdate *
Primary Emergency Contact #1(Parent/Guardian's Full Name) *
Primary Emergency Contact #1 Cell Phone *
Primary Emergency Contact #1 Work Phone *
Primary Emergency Contact #2 (Parent/Guardian's Full Name) *
Primary Emergency Contact #2 Cell Phone *
Primary Emergency Contact #2 Work Phone *
In the event of an emergency, a parent/guardian will be contacted. In the event the parent(s) cannot be contacted, the following person should be contacted:
Alternate Emergency Contact *
(Other than Parent/Guardian)
Relationship to Student *
Alternate Emergency Contact's Cell Phone *
Alternate Emergency Contact's Work Phone *
Allergies
Other Necessary Information
SUPPORT OF PARENT/STUDENT HANDBOOK
As a condition of your child’s enrollment at Concordia Lutheran High School, the parent/s and child are committed to adhere to the rules, regulations, policies and procedures of the Parent/Student Handbook as established by Concordia Lutheran High School.

Realizing that my attitude toward the teachers and the policies affects the emotional and academic stability of my child, we will support, pray for, and uphold the ideals of the school in every way and will abide by the discipline, regulations, and decisions of the administration. We will at no time participate in destructive criticism of the staff or school, to my child or others, but will instead, if a problem arises, go directly to the teachers or administrator in a Christian manner as indicated in Matthew 18:15.

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WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT IN CONSIDERATION FOR PARTICIPATION IN EXTRA-CURRICULAR EVENTS
In consideration for allowing my student to participate in extra-curricular events, I hereby release Concordia Lutheran High School, its employees, agents, representatives, and volunteers (hereinafter referred to as “Concordia Lutheran”) and agree to indemnify and hold harmless from liability for or arising out of any PROPERTY LOSS, PROPERTY DAMAGE, BREACH OF CONTRACT, DECEPTIVE TRADE PRACTICES ACT VIOLATION, PERSONAL INJURY OR DEATH, whether or not such loss, damage, or violation was the fault or caused by the NEGLIGENCE of Concordia Lutheran High School.
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PARENT PERMISSION AND AUTHORIZATION FOR TREATMENT
I/We hereby authorize the Athletic Trainer(s), coaches, and other representatives acting on behalf of Concordia Lutheran High School, working under the supervision of a licensed physician, to evaluate and treat any injury/illness that occurs while on campus or at a Concordia sponsored event off campus. This includes any and all reasonable and necessary first-aid and preventative, therapeutic, and rehabilitative care for treatment of these injuries/illnesses within the scope of their training. In the event of an emergency in which medical treatment is required, I give permission to the Athletic Trainer(s), coaches, or other representatives of Concordia Lutheran to obtain emergency treatment or the services of a licensed physician.
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PHOTO/TESTIMONIAL RELEASE
I/We give Concordia Lutheran High School (herein, “Concordia”), and/or its employees, designees, agents, independent contractors, legal representatives, successors and assigns, and all persons or departments for whom or through whom it is acting, the absolute right and unrestricted permission to take, use my name, testimonial and biological data and/or publish, reproduce, edit, exhibit, project, display and/or copyright photographic images or pictures of me or my child(ren), whether still, single, multiple, or moving, or in which I (they) may be included in whole or in part, in color or otherwise, through any form of media (print, digital, electronic, broadcast or otherwise) on campus or elsewhere, for art, advertising, recruitment, marketing, fundraising, publicity, archival or any other lawful purpose.
I waive any right that I may have to inspect and approve the finished product that may be used or to which it may be applied now and/or in the future, whether that use is known to me or my child(ren) or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image or product.
I release and agree to hold harmless Concordia, its Board of Directors, officers, employees, faculty, agents, nominees, departments, and/or others for whom or by whom Concordia is acting, of and from any liability by virtue of taking the pictures or using the testimonial/biographical data, in any processing tending towards the completion of the finished product, and/or any use whatsoever of such pictures or products, whether intentional or otherwise.
I am joined herein by my parent or legal guardian and this release is signed voluntarily, under no duress, and without expectation of compensation in any form now or in the future.

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