LINGLESTOWN LIFE STUDENT REGISTRATION FORM

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LINGLESTOWN LIFE STUDENT REGISTRATION FORM - CHILDREN'S MINISTRY

2021-22 SUMMER AND SCHOOL YEAR

So that our servants have all the information they need to safely minister to your child, please complete this registration form. Each child participating in ministry needs a separate registration. If you have questions, contact Sarah Axtman, Minister of Discipleship for Children and Youth, at saxtman@linglestownlife.org. Thank you!

LAST NAME OF STUDENT *

FIRST NAME OF STUDENT *

MINISTRY LEVEL YOUR STUDENT WOULD ATTEND ON SUNDAY MORNING *

NURSERY CARE (AGE 3 months to 2 1/2 yrs)

PRESCHOOL LITTLE DISCIPLES I (AGE 2 1/2 TO 4)

PRESCHOOL LITTLE DISCIPLES II (AGE 4 OR PRE-K, NOT YET IN KINDERGARTEN)

KINDERGARTEN, FIRST OR SECOND GRADE (KIDZ ZONE)

THIRD, FOURTH OR FIFTH GRADE (KIDZ ZONE)

NAME OF SCHOOL YOUR STUDENT ATTENDS DURING THE WEEK *

STUDENT BIRTHDAY *

YYYY

PRIMARY MAILING ADDRESS OF STUDENT *

STUDENT EMAIL (IF NOT APPLICABLE, WRITE 'NONE') *

ANY KNOWN ALLERGIES OR NEEDED ACCOMMODATIONS FOR STUDENT. IF SO, PLEASE DESCRIBE. PLEASE KNOW THAT KIDZ ZONE STUDENTS WILL HAVE CLASS OUTSIDE AT LEAST THROUGH THE END OF JULY. *

PARENT/GUARDIAN 1 NAME *

PARENT/GUARDIAN 1 ADDRESS *

PARENT/GUARDIAN 1 EMAIL *

PARENT/GUARDIAN 1 CELL PHONE *

PARENT/GUARDIAN 2 NAME *

PARENT/GUARDIAN 2 ADDRESS (IF SAME AS 1, JUST SAY 'SAME') *

PARENT/GUARDIAN 2 EMAIL (IF SAME AS 1, JUST SAY 'SAME') *

PARENT/GUARDIAN 2 CELL PHONE *

NAME OF PERSON OVER THE AGE OF 14, OTHER THAN PARENT/GUARDIAN 1 OR 2, WHO HAS PERMISSION TO PICK UP YOUR CHILD FROM OUR MINISTRY AREA. PHOTO ID MAY BE REQUESTED. *

FOR PARENT/GUARDIAN: BY ENTERING MY NAME, I GIVE PERMISSION FOR THIS STUDENT TO PARTICIPATE IN THE ACTIVITIES OF LINGLESTOWN LIFE UNITED METHODIST CHURCH (LLUMC) AND ITS CHILDREN / YOUTH PROGRAM, BOTH ON CHURCH PREMISES AND ELSEWHERE. *

FOR PARENT/GUARDIAN: BY ENTERING MY NAME, I UNDERSTAND THAT THIS STUDENT MAY BE PHOTOGRAPHED OR VIDEOTAPED WHILE PARTICIPATING IN SAID ACTIVITIES, AND I GRANT PERMISSION FOR A RECOGNIZABLE IMAGE TO BE POSTED ON APPROPRIATE LLUMC SOCIAL MEDIA PLATFORMS AND OCCASIONAL PRINT MEDIA. *

FOR PARENT/GUARDIAN: BY ENTERING MY NAME, I AGREE TO DISCUSS WITH THIS STUDENT THE REQUIREMENT FOR HIM OR HER TO ABIDE BY ANY NECESSARY HEALTH AND SAFETY PROTOCOLS REQUIRED BY LLUMC IN ORDER FOR AN EVENT TO OCCUR. *

FOR PARENT/GUARDIAN: BY ENTERING MY NAME, IN CONSIDERATION OF THE OPPORTUNITY OF THIS STUDENT TO PARTICIPATE IN THE ACTIVITIES OF LLUMC, I RELEASE LLUMC, ITS STAFF, AND ITS VOLUNTEERS FROM ANY AND ALL LIABILITY OF ANY KIND WHATSOEVER FOR ANY LOSS OR INJURY TO THIS STUDENT ARISING FROM ACTIVITIES ON OR OFF THE PREMISES OF LLUMC OR RESULTING FROM TRAVELING TO OR FROM THE ACTIVITIES OF LLUMC, INCLUDING LOSS OR INJURY RESULTING FROM NEGLIGENCE OR GROSS NEGLIGENCE. I UNDERSTAND AND AGREE THAT THIS PERMISSION AND AGREEMENT SHALL REMAIN IN EFFECT UNTIL REVOKED IN WRITING BY ME. *

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