MLC Youth Registration Form

Child 2 Information
C2-First Name
C2-Last Name
C2-School Grade Level
C2-Birthday

MonthDayYear
Date
C2-School Attending
C2-Baptism Month
Participation: Please check any activities below that this child may be participating in this year. This helps us reach out to you as these activities are scheduled.
C2- MLC Activity Participation (check all that apply)*

Sunday School (PreK - Gr. 12)First Communion Instruction (ages 7+)Acolyte Training (Grade 4+)Confirmation Classes (Grade 8+)Youth Fellowship Programming -MOES, MESY, Jr/Sr Youth (PreK - Gr. 12)Youth Music Programming, Wednesday Evening -Cherub/Seraph Choirs (PreK - Gr. 6)Receive a Bible from MLC (Grade 3+)
Medical / Dietary / Special Concerns: If this child has a medical, behavorial, dietary, or learning condition that is important for us to know while they are in the care of MLC leaders, please briefly summarize them below and we will follow up with you. If no significant concerns exist, please write "None" in the box below.
C2- Concerns or Conditions *
We will reach out to you for specifics on your child's concerns and work with you on making the Sunday School time safe and rewarding for your child.
Do you have additional children to register?

YesNo

Child 3 Information
C3-First Name
C3-Last Name
C3-School Grade Level
C3-Birthday

MonthDayYear
Date
C3-School Attending
C3-Baptism Month
Participation: Please check any activities below that this child may be participating in this year. This helps us reach out to you as these activities are scheduled.
C3- MLC Activity Participation (check all that apply)*

Sunday School (PreK - Gr. 12)First Communion Instruction (ages 7+)Acolyte Training (Grade 4+)Confirmation Classes (Grade 8+)Youth Fellowship Programming -MOES, MESY, Jr/Sr Youth (PreK - Gr. 12)Youth Music Programming, Wednesday evening -Cherub/Seraph Choirs (PreK - Gr. 6)Receive a Bible from MLC (Grade 3+)
Medical / Dietary / Special Concerns: If this child has a medical, behavorial, dietary, or learning condition that is important for us to know while they are in the care of MLC leaders, please briefly summarize them below and we will follow up with you. If no significant concerns exist, please write "None" in the box below.
C3- Concerns or Conditions *
We will reach out to you for specifics on your child's concerns and work with you on making the Sunday School time safe and rewarding for your child.
Do you have additional children to register?

YesNo

Child 4 Information
C4-First Name
C4-Last Name
C4-School Grade Level
C4-Birthday

MonthDayYear
Date
C4-School Attending
C4-Baptism Month
Participation: Please check any activities below that this child may be participating in this year. This helps us reach out to you as these activities are scheduled.
C4- MLC Activity Participation (check all that apply)*

Sunday School (PreK - Gr. 12)First Communion Instruction (Grade 2+)Acolyte Training (Grade 4+)Confirmation Classes (Grade 8+)Youth Fellowship Programming -MOES, MESY, Jr/Sr Youth (PreK - Gr. 12)Youth Music Programming, Wednesday evening -Cherub/Seraph Choirs (PreK - Gr. 6)Receive a Bible from MLC (Grade 3+)
Medical / Dietary / Special Concerns: If this child has a medical, behavorial, dietary, or learning condition that is important for us to know while they are in the care of MLC leaders, please briefly summarize them below and we will follow up with you. If no significant concerns exist, please write "None" in the box below.
C4- Concerns or Conditions *
We will reach out to you for specifics on your child's concerns and work with you on making the Sunday School time safe and rewarding for your child.
Do you have additional children to register?

YesNo

Child 5 Information
C5-First Name
C5-Last Name
C5-School Grade Level
C5-Birthday

MonthDayYear
Date
C5-School Attending
C5-Baptism Month
Participation: Please check any activities below that this child may be participating in this year. This helps us reach out to you as these activities are scheduled.
C5- MLC Activity Participation (check all that apply)*

Sunday School (PreK - Gr. 12)First Communion Instruction (ages 7+)Acolyte Training (Grade 4+)Confirmation Classes (Grade 8+)Youth Fellowship Programming -MOES, MESY, Jr/Sr Youth (PreK - Gr. 12)Youth Music Programming, Wednesday evening -Cherub/Seraph Choirs (PreK- Gr. 6)Receive a Bible from MLC (Grade 3+)
Medical / Dietary / Special Concerns: If this child has a medical, behavorial, dietary, or learning condition that is important for us to know while they are in the care of MLC leaders, please briefly summarize them below and we will follow up with you. If no significant concerns exist, please write "None" in the box below.
C5- Concerns or Conditions *
We will reach out to you for specifics on your child's concerns and work with you on making the Sunday School time safe and rewarding for your child.
Do you have additional children to register?

YesNo

Authorized Individuals: MLC leaders will only release children to the parent or guardians listed above. If there are other individuals permitted to pick up your children at the conclusion of an activity, please list their full names and relationship to the children here.
We will reach out to you for specifics on your child's concerns and work with you on making the Sunday School time safe and rewarding for your child.
Please include any other important information about your children below. If necessary we will follow up with you personally.
Photo Release: I understand that during church related activities pictures may be taken of my child(ren) to record and capture the event taking place. I give permission for my child(ren)’s image to appear in church publications such as, but not limited to, the church newsletter, member e-newsletters, website, online galleries, livestream, internet posts, printed publications, etc.

MLC staff and youth leaders will not take individual photos of minors, except for making things like internal class rosters and craft projects. Children in photos will NOT be identified by name.
Photo Release*

I consent to the Photo Release as written aboveI do NOT consent to the Photo Release as written aboveOther
Participation Consent: I give permission for my child(ren) to participate fully in Youth and Education programing at Messiah Lutheran Church, including classroom activities, worship activities, games, snacks, and on site recreation activities. I give permission for my child(ren) to participate in any off site programming where I provide transportation to the activity for my child(ren), or my child(ren) provide their own transportation.

Medical Treatment Authorization:
I understand that I will be notified in case of a medical emergency involving my child(ren). However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child(ren) is injured or becomes ill. I understand that the church will not be responsible for medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

I agree to notify the church in the event of any health changes which would restrict my child(ren)’s participation in any normal youth or children’s activities.

I also understand that the adult supervisors reserve the right to restrict my child(ren) from any activities that they do not feel are within the physical capabilities of my child(ren).
Physician / Clinic Name
Physician/Clinic Phone Number
Please sign with your finger or mouse that you have read the above and give permission for your child to participate in Sunday School and other MLC activities.

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Messiah Lutheran Church - Youth and Education Registration Form

Child 1 Information

Child 2 Information

Child 3 Information

Child 4 Information

Child 5 Information

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