2022 Children and Youth Registration

School Year 2022/2023
FOR ALL SUNDAY MORNING CHILDREN & WEDNESDAY NIGHT YOUTH PROGRAMS

FAMILY INFORMATION
Parent/Guardian #1 Name: *
Parent/Guardian #1 Cell * - (###) - ### ####
Parent/Guardian #1 Email
*
Parent/Guardian #2 Name:
Parent/Guardian #2 Cell - (###) - ### ####
Parent/Guardian #2
Email
Home Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
CHILD(REN) INFORMATION
Child #1 Name * First Last
Child #1 Birth Date * / MM / DD YYYY
Child #1 Grade in School: *
Child #1 Allergies, special needs, medical conditions, etc.: *
Child #2 Name First Last
Child #2 Birth Date / MM / DD YYYY
Child #2 Grade in School:
Child #2 Allergies, special needs, medical conditions, etc.:
Child #3 Name First Last
Child #3 Birth Date / MM / DD YYYY
Child # 3 Grade in School:
Child #3 Allergies, special needs, medical conditions, etc.:
EMERGENCY INFORMATION
Emergency Contact person (other than parent): * First Last
Relationship to child(ren):
*
Emergency Contact phone number * - (###) - ### ####
Acknowledgements, Permissions & Medical Release
Checkboxes * I give Family of Christ Lutheran Church permission to take photography and/or video of my child(s) while participating in church activities, and use photos/videos for promoting Family of Christ programs. I agree to release all liability from Family of Christ Lutheran Church (staff, members and volunteers) if my child(s) are injured in any way during church activities. I grant permission to Family of Christ Lutheran Church personnel to seek emergency medical treatment for my child(s) should it be needed. I understand they will make every reasonable effort to contact me or the emergency contact I provide on this form.
SIGNATURE * By checking this box I agree to the above and therefore sign this form
REGISTRATION FEES:
$15 per child for Sunday School and $50 for Confirmation to be paid to office with check or cash. You will be directed to the online giving to use credit card.
Section Break

2022 Children and Youth Registration

2022 Children and Youth Registration

FAMILY INFORMATION

CHILD(REN) INFORMATION

EMERGENCY INFORMATION

Acknowledgements, Permissions & Medical Release

Section Break