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Digital RELEASE OF LIABILITY and Medical Form Redeemer Lutheran Church: Rochester, MN. - Form for Minors
CAUTION: THIS IS A RELEASE-READ CAREFULLY BEFORE SUBMITTING
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I realize that this form is valid for 1 year from submission
*
Yes
No
Name of Child Participant
*
Your answer
Address (City, State, Zip)
*
Your answer
Participant Phone Number
*
Your answer
Participant email
*
Your answer
Print the names of parent(s) and/or legal guardian(s).
*
Your answer
Guest of: (if youth is not a member of Redeemer)
Your answer
Age of Participant
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Academic Grade (2021-2022)
*
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
School
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