Messiah Child & Youth Registration Form

Child & Youth Registration Form

Children's Sunday School
At Messiah, we love having our young people in worship AND also want them to learn about Jesus in a developmentally appropriate way. That's why during the school year we use the Whirl! Lectionary Sunday School curriculum to help our young people (pre-k through sixth grade) learn about the same Bible verses their parents and guardians are discussing in Mass. Children stay in worship through the Children's Message then head down to our Youth Wing with our awesome Sunday School Leaders for a roughly forty-five minute lesson before coming back up for Holy Communion with their families. We take safety seriously at Messiah, and thus require a brief registration form to be completed before children begin in Sunday School. Parents or guardians are responsible for updating this information if it changes throughout the program year (i.e. changes to allergies, medical history, emergency contact information).
Child/ Youth's Name:
First, Middle, Last Name
Child/ Youth's Age:
Child/ Youth's Date of Birth:

MonthDayYear
Date
Child/ Youth's Grade:
Child/ Youth's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian Information

Please list your name and contact information and the name and contact information for a second parent/ guardian, if applicable.
Parent/ Guardian Name:
Parent/ Guardian Mobile Phone Number:
Parent/ Guardian Email Address:
example@example.com
Second Parent/ Guardian Name (if applicable):
Second Parent/ Guardian Mobile Phone Number (if applicable):
Second Parent/ Guardian Email Address (if applicable):
example@example.com
Is there a court order in place that lists certain persons who are not authorized to pick up your child/ youth from Messiah? If so, please list names of those persons below.
Emergency Contact Information

Please list, in order, two persons that we can contact in the event of an emergency. We will call the first person listed first and continue down the list until we have made contact.
Name:
Mobile Phone Number:
Relationship with Child/ Youth:
Name:
Mobile Phone Number:
Relationship with Child/ Youth:
Medical History

Please complete the following basic medical information about your child/ youth to help our staff and volunteers keep them healthy and safe. Many questions are optional but are helpful especially for older youth who may attend multi-day events.
Does your child/ youth have any of the following conditions?

Other
If you checked any of the conditions above, please explain below:
Does your child have any special needs that we should be aware of? If so, please explain best you can and someone will follow up with you.
Is your child allergic to any of the following items or have any of the following dietary restrictions?

Other
If you checked any of the conditions above, please explain below:
Does your child/ youth carry an epi-pen?
Does your child/ youth carry an inhaler?
Is there anything else you would like for us to be aware of relative to your child/ youth’s health or past medical history?
Permission to Treat, Photo Release and Waiver
Please check the over-the-counter medications that are acceptable for your child/ youth to take if needed:
By signing below, the parent/legal guardian of the above named child/ youth, authorizes the Evangelical Lutheran Church of the Messiah (hereafter Messiah Lutheran Church) staff and/or volunteers and the medical personnel they have selected to consent to any medical/hospital care deemed necessary. The parent/legal guardian further consents to the release of this health history to the emergency room, hospital or doctor’s office providing care. Messiah will endeavor, but is not required, to communicate with the parent/ legal guardian prior to treatment. The undersigned releases Messiah and its staff and/or volunteers from any liability and claims arising from any consent given in good faith and in connections with diagnosis or treatment.
By signing below, the parent/legal guardian of the above named child/ youth, authorizes Messiah Lutheran Church and its staff and/or volunteers to utilize appropriate photographic and/or video images of the child/ youth in line with Messiah's SafeChurch policy. The parent/legal guardian understands that neither they nor the child/ youth will receive compensation, should any photograph and/or video of my child be published. The undersigned, as parent/legal guardian of the above named youth, hereby release, forever discharge and agree to hold harmless Messiah Lutheran Church, its staff and/or volunteers from and against any and all kind of liability, claims, demands, lawsuits, and expense of any kind arising from personal injury, sickness, death or property damage of any kind whatsoever which may be incurred or by virtue of the child/ youth’s participation in faith formation, fellowship and other programming at Messiah Lutheran Church. The undersigned certifies they have full authority to sign this Permission to Retreat, Photo Release and Waiver.
Parent/ Guardian Printed Name
Parent/ Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

Child & Youth Registration Form

Parent/ Guardian Information

Emergency Contact Information

Medical History

Permission to Treat, Photo Release and Waiver