Redeemer Youth Form 2025-2026

Redeemer Youth Form 2025-2026
Youth-FULL Name:

First & Middle NameLast Name
Prefers being called:
Regarding ministry text announcements:
2025-2026 Grade:
School:
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preferred pronoun:

Other
Youth T-Shirt Size (Adult Sizes Only):
Youth Cell #:
Please enter a valid phone number.Format: (000) 000-0000.
Youth Cell Provider:
Youth Email:
Youth email can be used for youth announcements:
Favorite snack and/or treat:
Generally speaking, how does your youth prefer to be recognized/celebrated (i.e. accomplishments, birthdays, etc.)
Any additional details you'd like to add to the question above?
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you are a visitor, which Redeemer Youth are you visiting?
We share photos on our website, newsletter, and social media. May we share photos and/or videos of your youth to: social media, private Redeemer Youth Facebook group, private Redeemer Members Facebook group, Redeemer website, Redeemer Youth Newsletter, Redeemer Newsletter, email, and Google Photos or other places where photos are stored?

Other
If "Other", please list areas approved for photo/video sharing:
Parent(s)/Legal Guardian(s):
Parent/Guardian 1 Cell #:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Cell Provider:
Parent/Guardian 1 Work #:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Email:
example@example.com
Parent/Guardian 2 Cell #:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Cell Provider:
Parent/Guardian 2 Work #:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Email:
example@example.com
Parent/Guardian 2 Address (if different from youth's above):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which Parent/Guardian to contact?
Emergency Contact Name (if parents cannot be reached):
Relation to student:
Cell #:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone #:
Please enter a valid phone number.Format: (000) 000-0000.
Do you have health insurance?
Medical Insurance Company:
Policy #:
Phone Number:
Medical Information (please inform us of any changes throughout the year)

In the case of overnight trips-medication will be collected & kept with an adult leader and administered as directed.
Food and drug allergies:
Other health issues:
Is your youth up-to-date on COVID-19 vaccine based on current CDC guidelines (you are up to date with your COVID-19 vaccines when you have received all doses in the primary series and all boosters recommended for you, when eligible)?
You have permission to give my youth (please check all that apply):
Other regular medications with dosage/schedule to be taken for trips/overnights:(*medication must be sent in original container.)
Please indicate ANYTHING else which leaders should know in order to respond to and support your youth’s health. Include medications, medical or behavioral health conditions, disabilities (including learning disorders), and restrictions to physical activity.
Medical and Liability Release of a Minor or Self
I hereby indemnify and hold Lutheran Church of the Redeemer from and against any liabilities that may be incurred during 2025-2026 Youth Ministry events (including travel to and from events). I also authorize, in the event that I cannot be personally contacted, Lutheran Church of the Redeemer and/or its agent to authorize any medical treatment for the heath/welfare of my youth in connection with any accident or similar emergency. I understand that I am responsible for any charges that may be incurred for such medical treatment. I also understand that my child’s failure to abide by the Safe Community Commitment may result in being sent home at my own expense. This release is valid until August 2026. Parent/guardian please sign below.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Redeemer Youth Form 2025-2026

Medical Information (please inform us of any changes throughout the year)

Medical and Liability Release of a Minor or Self