F.L.Y. Club Registration Form

Student Registration Form for F.L.Y. Club

F.L.Y. Club is an afterschool program put on by First Lutheran Church for school age children. This program is to create and nurture children's faith to help them speak confidently to their peers about who Christ is. The classroom provides a space where the children can challenge their faith with grace and mercy. They will meet every Wednesday after school until 5:30 unless noted. Curriculum will be Answers in Genesis. On the last Wednesday of every month, the children will create and cook a meal for their families as we know how important it is to slow down and connect with each other. Contact Jessica Pellinen, Family Ministry Program Director at 218-999-4102 with questions.
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Grade
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parents Name

First Name Last Name
Parent E-mail
example@example.com
Mobile Number
Phone Number
Emergency Contact Information

First Name Last Name
Phone Number
Please enter a valid phone number.
How will your child get to First Lutheran? We are working with the bus garage to provide busing to the church. You may need to fill out the transportation form on your end.
Please list your home church
Please list your child's allergies, behavior or medical concerns we should be aware of.
Additional Comments
PHOTOGRAPH RELEASE CONSENT FORPARTICIPANT: I grant to First Evangelical Lutheran Church, its representatives and employees the right to take photographs of my child and my property in connection at any F.L.Y. Club event. I authorize First Evangelical Lutheran Church, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that First Evangelical Lutheran Church may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Yes No
PARTICIPATION AGREEMENT: I agree to abide by any/all policies and rules established for this event/activity. Should your child not be able to maintain the guidelines and expectations of the adults and their peers, I understand that there will be consequences for their actions, including being removed from the activity and being sent home. I hereby give permission to actively participate (myself or my minor child) in the activities and events of First Evangelical Lutheran Church during F.L.Y. Club. I also understand that I or my child will be expected to participate in all spiritual activities including Bible Study and devotions during the event. I hereby release and forever discharge First Evangelical Lutheran Church, their agents and servants, successors and assigns, directors, trustees, officers, employees, and other representatives against loss from any and all present or future claims, demands, or actions in law or in equity that may hereafter be made or brought by me or my child, by anyone on behalf of me or my child, or by anyone else on their own behalf for damages or any other legal or equitable remedy on account of any injury, illness, physical condition, inconvenience, or loss sustained by me or my child during participation in programs, activities or events held by First Evangelical Lutheran Church.

Yes No
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Student Registration Form for F.L.Y. Club