Children and Youth Registration Form
Trinity Lutheran Church, 47 W. Main Street, Mount Joy PA
Child's First Name
Your answer
Child's Last Name
Your answer
Child's Birthdate
Your answer
Child's Grade in School (List "Preschool" if not yet in school)
Your answer
Child's Age as of September 10, 2017
Your answer
Names of Guardians
Your answer
Parent Cell Phone Numbers
Your answer
Emergency Contact (Name, relationship, cell number)
Your answer
Parent Email
Your answer
Parent alternate email
Your answer
Mailing Address
Your answer
Medical Permission - My child has my permission to participate in youth events at Trinity Lutheran Church, Mount Joy PA. In the event that I can not be found, permission is given to have treatment in a medical facility as deemed necessary.
Allergies and Medical Conditions
Your answer
Photo Permission - We at Trinity Lutheran Church occasionally use the photographs of children and youth for websites, newsletters, and other in-house publications. It is our practice to not list the name of the child or youth with the photograph without prior parental permission.
All children in grades K and under are required to be picked up by a parent. If your child is in grades 1 and higher, we need your permission to release them without a parent present.
Required
Other information we should know about your child
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The undersigned does hereby agree to hold harmless, release, remise, acquit and forever discharge Trinity Lutheran Church, its staff, employees, volunteers, agents, successors and assigns, of and from all claims, demands, causes of action, obligations, rights, damages, losses, expenses, costs, joinders or controversies arising out of my child’s participation in any program or any activities with Trinity Lutheran Church.
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