Children, Youth & Family Registration

PERMISSION STATEMENTS:

The form on this page will be considered your permission for your child to participate in all faith formation activities that are offered on and off site by First Lutheran Church for the 2023-2024 school year with groups from First Lutheran Church. (Please note most outside events require their own release forms.)

I give permission to adult leaders with First Lutheran Church to seek medical treatment for my child in the event of an emergency injury or illness. I also grant permission to the physician selected by First Lutheran Church leaders to secure and administer any treatment deemed necessary, including ambulance transfer and hospitalization. I understand every attempt will be made to contact me or those listed on this form as emergency contacts if such an event occurs.

I give permission for my child’s photos to be taken by First Lutheran Leaders and Volunteers and used on a variety of promotional materials (newsletters, Facebook Group page, church bulletin boards, and/or website).

Child #1 Information

Child #1 Name *

First

Last

Child #1 Parent/Guardian Name(s) *

Child #1 Date of Birth *

Type in the date
Is child #1 baptized? *

Yes No

Child #1 Grade *
Child # 1 Cell Phone (if available)

Additional Children

Click "Next" to skip this page if registering only one child

CHILD #2

Child #2 Name

First

Last

Child #2 Parent/Guardian Name(s)

Leave blank if same

Child #2 Date of Birth

Type in the date
Is Child #2 baptized?

Yes No

Child #2 Grade
Child #2 Cell Phone (if available)

CHILD #3

Child #3 Name

First

Last

Child #3 Parent/Guardian Name(s)

Leave blank if same

Child #3 Date of Birth

mm/dd/yy
Is Child #3 baptized?

Yes No

Child #3 Grade
Child #3 Cell Phone (if available)

CHILD #4

Child #4 Name

First

Last

Child #4 Parent/Guardian Name(s)

Leave blank if same

Child #4 Date of Birth
Is Child #4 baptized?

Yes No

Child #4 Grade
Child #4 Cell Phone (if available)

CHILD #5

Some description about this section

Child #5 Name

First

Last

Child #5 Parent/Guardian Name(s)

Leave blank if same

Child #5 Date of Birth
Is Child #5 baptized?

Yes No

Child #5 Grade
Child #5 Cell Phone (if available)

Address

Address Field

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Contact Phone

May use "Cell Phone" instead

Cell Phone

Text Messages:

Yes No

Email Address *

Alternative Contact (1) *

Alternative #1 Phone *

Contact #1 Relationship to: *

Alternative Contact (2)

Alternative #2 Phone

Contact #2 Relationship to:

Insurance - Medical

Insurance Company *

Insurance Policy and/or Group Number *

Medical/Health Notes (optional)

List any special medical conditions, allergies, or other medical information for each child.

Parents' Occupation or work hour considerations (optional)

List skills that might be helpful or work considerations that may affect a child's participation.

I have read and agree to the PERMISSION STATEMENTS

Signature Field *

Electronic Signature Required