Student Ministries - Youth Group Registration

Youth Information
Student Name Student Name First Middle Last
Student Birthday Student Birthday / MM / DD YYYY
Student Email
Student Number Student Number - ### - ### ####
Permission To Text

Permission To Text Yes No
Grade
Must be a number between 6 and 12
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent Information
Parent Name Parent Name First Middle Last
Parent Name Parent Name First Middle Last
Parent Email
Parent Number Parent Number - ### - ### ####
During youth group meetings, activities and large events, we will take pictures and audio/video for use on Faith's website, social media and promotional materials (no names will be posted).

If you wish for your daughter/son to be INCLUDED in photos/audio/videos, please indicate by selecting the box:

During youth group meetings, activities and large events, we will take pictures and audio/video for use on Faith's website, social media and promotional materials (no names will be posted).

If you wish for your daughter/son to be INCLUDED in photos/audio/videos, please indicate by selecting the box: I wish for my child to be INCLUDED in photos and audio/videos.
Medical Information
Emergency Contact Name Emergency Contact Name First Middle Last
Emergency Contact Number Emergency Contact Number - ### - ### ####
List any allergies, medical conditions, or special concerns that we need to know that might present a challenge with snacks, high intensity youth group games, or off-site trips:
In the event of an illness or accident which requires immediate medical treatment, at a time when a parent or legal guardian cannot be located, I (the undersigned) give my permission for leaders of Faith Lutheran Church and/or it's church staff to authorize treatment for my daughter/son. I will not hold Faith Lutheran Church or medical personnel responsible. This is done with understanding that every attempt has been made to contact the parents/legal guardians.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Group Registration
My first choice for a group would be
My second choice for a group would be

Student Ministries - Youth Group Registration

Student Ministries - Youth Group Registration

Youth Information

Parent Information

Medical Information

Group Registration