Registration Form

2024-25 Student Registration

Student Name *

First

Last

Birth Date *

Gender *

Grade *

Baptism *

Yes, child is baptized No, would like to wait No, would like to have them baptized soon

Receiving Communion? *

Yes No, would like to wait No, would like more info on first communion

If baptized, date and location *

Medical Information (list any allergies, injuries, medical conditions, etc.) *

Parent/Guardian #1 *

First

Last

Phone Number *

Email *

Parent/Guardian #2 *

First

Last

Phone Number *

Email *

Student Primary Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact #1 *

First

Last

Phone Number *

Emergency Contact #2 *

First

Last

Consent/Medical Release *

I am the parent/legal guardian of the participant, and hereby grant my permission for them to participate fully in Our Savior’s Lutheran Church related trips and activities. In the event of an emergency, and I cannot be reached, I give permission for the supervising Our Savior’s Lutheran staff or the available adult leader to sign forms that would ensure the NECESSARY and IMMEDIATE 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. (Please attach a clear statement regarding the treatment of your child in the event of an emergency if different than the instructions stated in this paragraph. Sign and date the statement, please.) Further, I understand that the child-participant cannot use alcohol, tobacco, drugs, firearms, or fireworks at any Our Savior’s Lutheran sponsored activity, regardless of location. If those rules are broken, I hereby assume transportation costs incurred for immediately returning the student home.

Phone Number *

Photo Release *

I understand that during youth activities at Our Savior’s Lutheran Church, pictures may be taken of my child. I grant OSLC permission to use them for promotional (i.e. newsletter, website, & facebook) purposes with the understanding that their names will not appear with the photo. No, don’t use any pictures

Submit