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Redeemer Youth Registration and Permission Form
This authorization is valid from August 27, 2017 - August 31, 2018
Redeemer Lutheran Church, 1545 Chain Bridge Rd, McLean, VA 22101
Contact us at 703-356-3346
Email address
Youth Name
Your answer
Grade
Birth Date
MM
/
DD
/
YYYY
Baptismal Date
MM
/
DD
/
YYYY
Parent Name(s)
Your answer
Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Best email address(es) to use
Your answer
Allergies
Your answer
Dietary Restrictions
Emergency Contact (name, relationship, phone)
Your answer
Permission to participate in youth activities: I hereby grant permission for my child to participate in Redeemer Youth Ministry activities under the supervision of adult chaperones. I understand my child may engage in physical activities with risk of injury.
Required
Permission for Emergency Medical Treatment: In the event that I cannot give authorization in person, I hereby authorize an adult chaperone from Redeemer Lutheran Church to seek emergency medical treatment for my child.
Permission for Photography: I give permission for my child's picture to be placed on Redeemer's website.
Please complete the captcha before submitting the form.
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