Course Registration Form

Redeemer and St. Stephen Lutheran Churches Wednesday Evening Children and Youth Program Registration

Each church will have their own form for Sunday morning education
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Mobile Number*
Format: (000) 000-0000.
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Which class(es) will your child be attending?*
Please let us know any information about your child that will help them thrive at Redeemer and St. Stephen Lutheran Church.
Release of Liability I, the undersigned, as the parent or legal guardian of the above-named child, hereby acknowledge and agree to the following:Assumption of Risk: I understand and acknowledge that participation in VBS activities involves inherent risks, including but not limited to physical activity, outdoor play, and crafts, which may result in personal injury. I voluntarily assume all risks associated with my child(ren)’s participation in VBS.Release and Waiver: I release, waive, and hold harmless Redeemer Lutheran Church, St. Stephen Lutheran Church, their employees, volunteers, agents, and affiliates from any and all claims, liabilities, or damages arising out of or in connection with my child(ren)’s participation in VBS, except in cases of gross negligence or willful misconduct.Medical Authorization: In the event of an emergency, I authorize VBS staff and volunteers to seek medical treatment for my child(ren) as deemed necessary. I understand that every reasonable effort will be made to contact me before initiating medical treatment. I accept responsibility for any costs incurred for such treatment.*
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Redeemer and St. Stephen Lutheran Churches Wednesday Evening Children and Youth Program Registration