Spark Kids Registration

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Name of Child *

Date of Birth *

Grade for 2025-26 School year *

Gender

Boy

Girl

Prefer not to say

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Any medical issues/allergies. if more than one child include the name with the allergy. *

Mailing Address *

Parent/Guardian whom child lives with *

Best Phone number to use: *

Parent/Guardian email: *

Can we text you? *

Yes

Emergency Contacts: List 2 please. 1st person to call name first, please include phone numbers *

Please give details (name and phone number) of other persons who you authorize to pick up your child. *

I, who by law may do so, authorize the administration of emergency medical treatment to s/he who is subject of this form. I understand all reasonable safety precautions will be taken at all times by Custer Lutheran Fellowship and its agents to avoid accident, injury and disease, and I will therefore not hold Custer Lutheran Fellowship liable for any accident, injury or disease incurred by the subject of this form. I understand that in the event medical intervention is needed every attempt will be made to contact the person(s) listed on this form.

This form will remain in effect for one year only -- the 2025-2026 school year to include summer VBS. Please sign your name in the answer section if you agree.

Are there any family situations of which we should be aware? For example: custodial issues, other matters? *

Permission to participate in Activities: *

I consent to my child taking part in the approved program of activities for SPARK Kids at Custer Lutheran Fellowship

I consent to the possibility of my child having their picture posted on the Custer Lutheran Fellowship Facebook page, church website, bulletin boards and publications.

I consent to having my child in my care picked up/dropped off by a liscensed driver if need be, from Custer Lutheran Fellowship.

I consent to giving Custer Elementary School permission to let a CLF representative know if my child is absent from school that day.

Required

Parent Signature *

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