For youth in 6th-12th grade: Please list contact information for youth group and confirmation reminders. Youth cell number blank . Youth email blank.
For children in preschool through 5th grade (6th-12th grade please put N/A in the blank): Who may pick up/sign out your child? blanks* .
Are you a member of St. Paul Lutheran Church blanks. My church is blank.
How did you hear about St. Paul Lutheran Church blanks?
Parent volunteers are also needed. Please consider helping out! Serving on the education board, serving on the youth board, helping in the nursery, serving as a substitute teacher, planning or leading Sunday School crafts, assisting with the Christmas program, drivers, chaperones, assisting with music. Other special talents or hobbies you would be willing to shareblanks .
Preferred Doctor blanks* Phone numberblank*
Preferred Dentist blanks* Phone numberblank*
Insurance Provider Nameblanks Phone numberblank
Policy Holder's Name blanks*
Policy Number blanks* Group Numberblank*
Title XIXblanks
Release, Waiver & Permission to TreatI blanks* verify that the above medical information on my child is complete and accurate and that I have legal custody of the participant named above. I understand that there are inherent risks involved in any ministry and its related activities. I grant my permission for supervising adults to administer general first aid treatment for any minor injuries or illnesses experienced by my child. In the event of an emergency, I hereby authorize the calling deemed necessary by a licensed physician. I also agree to hold harmless St. Paul Lutheran Church, the church's called workers, employees, and volunteers from any and all liability for any injury, loss or damage to person or property that may occur during the course of my child's involvement in events sponsored by St. Paul Lutheran Church, including travel to and from these activities.
Photo Release Iblanks* hereby grant St. Paul Lutheran Church permission to take and use photographs/videos of the minor designated above for any purposed lawful at any time. I waive any right that I may have to inspect or approved the finished product or written copy of those photos and videos. This form will be valid for all activities sponsored by St. Paul Lutheran Church for one full year from the date below.