Youth Registration

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Youth Registration

Faith Lutheran Youth Ministry

Youth Full Name *

Birthday

School

Grade

Freshman

Sophomore

Junior

Senior

6th Grade

7th Grade

8th Grade

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Home Church

Parent / Guardians Name(s) *

Address

Youth Phone Number

Youth E-mail Address

Special Medical, health or allergy information we should know about? *

Medical Release- I give permission for my youth to attend the events sponsored by Faith Lutheran. I also authorize the adult responsible for this youth from Faith Lutheran Church in Lacey, WA to seek or provide medical care, or surgical care, including care rendered through the facilities of a physician or hospital for my youth in the event that an emergency arises and it becomes necessary for a physician to attend to my youth and I cannot be reached for consultation *

Yes

Emergency Contact name and phone number and relationship to child *

Insurance company and health plan and group # *

Physician's name and phone number *

I have read and agree with the youth policy manual (youth must answer) *

Yes

I have read and agree with the youth policy manual (parent or guardian must answer) *

Yes

I have read and agree with the fundraising policy (parent or guardian must answer) *

Yes

Faith Lutheran has permission to post my child's picture on Facebook, the website and e-newsletter (without name attached) *

Yes

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