Church School Registration 2024/25 School Year

Child's Name*

First NameLast Name

Date of Birth*

malefemale

Grade/Age*

Choose a Session*

Sunday Church School (begins Sept. 8 8:30-9:20am)Wednesday Church School (begins Sept. 11 5:30-6:20pm)

Parent/Guardian Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Preferred Phone Number *

Area CodePhone Number

Preferred Email Address*

In case of emergency, contact*

First NameLast Name

Emergency Phone Number*

Area CodePhone Number

May we release your child to this person?*

YesNo

Health Concerns, please specify

Are there any medical condition that LCOOR Staff and volunteers should be aware of in regard to your child's health (such as allergies, asthma, diabetes, etc)?

Permission (please check box if acceptable)*

I/We give permission for my/our child to participate in activities sponsored by Lutheran Church of Our Redeemer of Watertown, South Dakota. I/We understand that a church staff member(s) and/or volunteer chaperones will accompany my/our child and other children. I/We understand that the children may be transported in privately owned cars driven by parents of students. I/We agree that the travel arrangements are appropriate. I/We waive any claim against the church, its employees or the volunteer chaperones for any injury suffered by my child in excess of the church's insurance limits.In case of medical/dental emergency concerning my child, at a time when I/We cannot be notified, I/We hereby authorize Lutheran Church of Our Redeemer officials to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I/We give permission to those administering emergency treatment to do so using those measures deemed necessary, such as but not limited to x-ray examinations, anesthetics or medications, medical/surgical/dental diagnosis or treatment, and/or hospital care. I/We absolve Lutheran Church of Our Redeemer, its employees and volunteer chaperones from liability in acting on my behalf in this regard.I/We hereby grant Lutheran Church of Our Redeemer permission to use my child'slikeness in a photograph in any and all of its print publications andcommunication mediums such as website, e-mail, social networks, video,television, billboard, etc...without payment or other consideration.

Volunteer

Small Group Leader (Sunday)Small Group Leader (Wednesday)

Signature

Date

2024/2025 Church School Registration