God Squad

God Squad - Resurrection Lutheran Church

Ages 3 Years - 12th Grade. 2021-2022 School Year
Student Information
Child's Name

First Name Last Name
Birth Date *

Month Day Year
Gender
Age
Grade 2021/2022 School Year
Child's Name

First Name Last Name
Birth Date

Month Day Year
Date
Gender
Age
Grade 2021/2022 School Year
Child's Name

First Name Last Name
Birth Date

Month Day Year
Date
Gender
Age
Grade 2021/2022 School Year
Child's Name

First Name Last Name
Birth Date

Month Day Year
Date
Gender
Age
Grade 2021/2022 School Year
Parent Email Address
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number

Emergency Contact 1
Relationship to Child
Name

First Name Last Name
Phone Number

Area Code Phone Number
Emergency Contact 2
Relationship to Child
Name

First Name Last Name
Phone Number

Area Code Phone Number
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns. Please be specific.
Notes for Ministry Directors: Any other information that we should be aware of?

Permission To Use Photographs

Resurrection Lutheran Church - God Squad 2021/2022
I grant Resurrection Lutheran Church (RLC) the right to take photos of me and my family in connection with God Squad Ministery events. I authorize RLC its assign and transferees to copyright, use, and publish the same in print and electronically. I agree that RLC may use photos of me with or without my name and for any lawful purpose, including for example such as purposes as publicity, illustration, advertising, and web content.
Date

Month Day Year
Date
Parent/Guardians Printed Name

First Name Last Name
Signature

Clear
Should be Empty:

God Squad - Resurrection Lutheran Church