2018/19 REGISTRATION -- YOUTH MINISTRY

TRINITY'S SUNDAY PROGRAM FOR GRADES 5 & 6

EACH SUNDAY, 9:27 AM TO 10:27 AM

For more information on this exciting Sunday morning youth bible study, please contact Mandy Schafer, mschafer@trinityjoppa.org!

First Name: *

Last Name: *

Address:

City:

State:

ZIP Code:

Home Phone:

Cell Phone:

Email Address:

GENDER:

Female Male

Birth Date: *

- Month - Day Year

Grade in 2018/19: *

Please list any food allergy or other known allergies:

Name of Emergency Contact: *

Phone Number of Emergency Contact: *

Please indicate any information that would be helpful in assisting the instructor in teaching your youth personally in the classroom:

WHICH SUNDAY SERVICE WILL YOU NORMALLY ATTEND?

9:27 AM 11:00 AM

PARENT/GUARDIAN PHOTOGRAPHY RELEASE: For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent to and authorize the use throughout the universe by Trinity Evangelical Lutheran Childcare Center, Church and School, its legal representatives, successors and assigns, and all persons, corporations and other legal entities acting with its permission or upon its authority, of any photographic portraits or pictures of myself and family members, still, single, multiple or moving, or in which I (we) may be involved in whole or in part or composite, or distorted in character or form, or reproductions of these photographs, made through any media now known or hereafter invented, for the purpose of advertising, trade, internet distribution, fund raising, education or any other lawful purpose. I also consent to the use of my (our) name and voice in connection with the aforesaid photographs, including any endorsement or testimonial of any commercial product or service. I waive any right that I (we) may have to inspect and approve the finished product or the advertising copy that may be used in connection with the finished product, or the use to which it may be applied. I understand that Trinity Evangelical Lutheran Childcare Center, Church and School will act in reliance on this consent, and I hereby release and discharge Trinity Evangelical Lutheran Childcare Center, Church and School, its legal representatives, successors, assigns, and all persons, corporations or legal entities acting with its permission or upon it authority, from any and all claims whatsoever in connection with the lawful use of the photographs and the testimonial described herein. PLEASE VERIFY AGE FOR PHOTOGRAPHY RELEASE: *

I Am Over Eighteen (18 Years) Of Age.

Please List Family Name and Members:

PLEASE SELECT PHOTOGRAPHY PERMISSION: *

I Give Permission As Indicated In The Parent/Guardian Photography Release Above.. Please Do Not Use Any Images Of My Family In Any Way.

Parent/Guardian E-Signature: *

Date of E-Signature: *

- Month - Day Year

Email for Kru Form Submission Receipt: *

1100 Philadelphia Rd, Joppa MD 21085 (P) 410-679-4000 (F) 410- 679-3472

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TRINITY LUTHERAN CHURCH