Youth Ministry Registration Form

Child's Name

Date of Birth

Address

Program

Wednesday Night Childcare ECHO (k-2nd) Bible Explorers (3rd-5th) Confirmation (6th-8th) Pathways Senior High

Parent or Guardian Information

Parent/Guardian Name 1

This address will receive a confirmation email

Cell Phone

Parent/Guardian Name 2

Cell Phone

Emergency Contact

Emergency Contact Name:

Emergency Contact Phone #

Emergency Contact if parents cannot be reached:

Name #1

Relationship

Phone

Name #2

Relationship

Phone

Additional names of individuals who may pick up child from programs:

Medical Information

Medical Information:

Does your child have any special needs, considerations, or conditions?

Allergies

Medications:

Doctor Name:

Hospital Preference:

Permissions/Acknowledgements

PHOTOGRAPHY: I give permission for my child to be photographed for use by Holy Trinity Lutheran Church in publicity or advertisements, newspapers, the website, Facebook, Instagram, Twitter, and other media. Your child's photo may appear on bulletin boards or other spaces within the church building.

YES, I give permission for my child's photgraph to be used. No, my child's photograph MAY NOT be used.

MAILING/TEXTS LIST: I give permission to be added to the Holy Trinity Lutheran Church mailing/text list. This includes periodic mailings including upcoming events, weekly e-news, updates, and more.

WALKING PERMISSION FOR YOUTH (6th and older): I give permission for my child (6th grade and older) to walk to the parking lot/home independently. Yes, I give permission for my child to walk to the parking lot/home independently No, my child may not walk to the parking lot/home independently

By submitting this form, I acknowledge my support for the mission and vision of youth programming at HTLC. I understand the importance of partnering with staff and volunteers as they create a safe, nurturing, and faith filled environment for all children. I will work together with staff/volunteers to help my child grow in their relationship with the Triune God and the community.

By entering my name in the box below, I am providing my digital signature on this Youth Ministry Registration Form.

Electronic Signature

Youth Ministry Registration Form

Description

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