Confirmation / Youth Group Registration 2018-2019
I agree to give permission for my child to fully participate in all activities relating to Confirmation or Youth Group 2018-2019.

In case of emergency, I understand that every effort will be made to contact parent(s), guardian(s), or other relatives listed below. If these contacts cannot be reached, I hereby give the staff and appointed volunteers of First Lutheran Church permission to act on my behalf in seeking emergency treatment for my child/me in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measure deemed necessary. I understand that First Lutheran Church is not responsible for related injuries that may occur during this event.

What are you registering for? *
Name of Participant
Your answer
Grade Level of Participant
Your answer
Age of Participant
Your answer
Date of Birth of Participant
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DD
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YYYY
Parents/Guardians
Your answer
Mailing Address
Your answer
Home Phone
Your answer
Parent 1 Cell Phone
Your answer
Parent 2 Cell Phone
Your answer
Parent Email
Your answer
If parent or guardian is not available, please call relative below: Emergency Contact Name
Your answer
Emergency Contact Relation to Child
Your answer
Emergency Contact Phone Number
Your answer
Any allergies or reactions?
Your answer
Parent or Guardian Signature
Your answer
Date
MM
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DD
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YYYY
Please provide a copy of Participant's current Insurance card by email to Melissa at youth@flcbrainerd.com or drop it off to the FLC office/ATTN: Melissa. Thanks!
FLC sends information about upcoming events, concerns, weather related information and other program notes through email and text messages.
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