2024-2025 RLC Youth & Children's Ministry Registration

Contact email for the person filling out this form:

This address will receive a confirmation email

Participant Information

Name

Date of Birth

School attending during the 2024-2025 School Year

Address

Please list any allergies of which we should be aware:

Please list any other medical or behavioral concerns of which we should be aware:

FOR YOUTH MINISTRY (Grades 6-12) PARTICIPANTS: We occassionally communicate reminders and invitations to events directly with students in FaithBuilders (grades 6-8) and Youth Group (grades 9-12.) Please provide your student's contact information if we have permission to communicate with them via phone call, text, or email. All students who are permitted to receive emails and/or text messages will be automatically signed up for our email and text message lists.

Youth Email Address

Youth Phone Number

I give permission for my student to receive EMAILS about church-related activities. Yes No

I give permission for my student to receive TEXT MESSAGES about church-related activities. Yes No

Parent/Guardian Information

Parent/Guardian #1 Name

Address (if not same as participant address)

Phone

Email (if not same as email listed above)

We occassionally send reminders and information about children's and youth ministry events. Please let us know if you would like to opt-in to receive these specific reminders.

I would like to receive emails about children's and youth ministry reminders and events.

Yes No

I would like to receive text messages about children's and youth ministry reminders and events.

Yes No

Parent/Guardian #2 Name

Address (if not same as participant address)

Phone

Email (if not same as email listed above)

We occassionally send reminders and information about children's and youth ministry events. Please let us know if you would like to opt-in to receive these specific reminders.

I would like to receive emails about children's and youth ministry reminders and events. Yes No

I would like to receive text messages about children's and youth ministry reminders and events. Yes No

Emergency Contact Information

Emergency Contact Name

Relationship to Participant

Phone

Permissions and Releases

Image/Video Release: By selecting "YES" on the below Photo Release, you are authorizing Resurrection Lutheran Church to use images and/or video of the registered participant in Resurrection publications per the Photo and Video Privacy Policy.

Image/Video Release:

Yes, I authorize RLC to use images and/or video of the registered participant No, please do not use images and/or video of the registered participant without my written authorization

Consent and Release: By selecting “YES” on the below Consent and Release, you grant permission for the participant to fully engage in children's and youth ministry activities at Resurrection Lutheran Church.

Consent and Release:

Yes No

Medical Release: In the event of an emergency and I cannot be reached, I give permission for the supervising Resurrection Lutheran Church staff member or the available adult leader(s) to provide the necessary and immediate medical treatment of the participant. I give permission to those administering emergency treatment to do so using those measures deemed necessary. I furthermore absolve those acting on my behalf in this regard from liability as long as there is not gross negligence.

Medical Release:

Yes No

FOR NURSERY (ages 4 and under) PARTICIPANTS: I give permission for the on-duty nursery staff to change my child's diapers.

Yes No

2024-2025 RLC Youth & Children's Ministry Registration

Description

Please Fix the Following