House of Prayer Lutheran Church Children & Youth Registration 2017-18
House of Prayer offers numerous programs for children ages 4-18 to grow in faith and build community with other children. Sunday mornings we have Sunday School during both our 9:30am and 11:00am services for children pre-K through grade 4 starting September 10th and going through the end of May. Wednesday nights from 6:30-8:00pm we offer programs for youth in 5th-12th grade starting on September 13th and going through the end of May. We welcome all children, including guests or friends, to join us each week but this registration helps us know how many children to plan for and helps us keep parents up to date with updates and announcements. Please use this form to register your child for one or multiple of these programs, using one form per child. Thank you and see you soon!
Child's Name (first & last)
Your answer
Address (Street, City, State, Zip)
Your answer
Gender
Your answer
Birthdate (mm/dd/yyyy)
Your answer
Grade during 2017-18 School Year
Your answer
School attending
Your answer
Special needs or allergies
Your answer
Parent(s) Name(s)
Your answer
Home Phone Number
Your answer
Cell Phone Number (and whose phone it is)
Your answer
Parent/Guardian Email (list multiple if desired)
Your answer
I'd like to register my child for the following program(s):
Release Forms
Please read the following three paragraphs about emergencies, transportation, and media release. You will be asked to sign a paper copy of these agreements, as well as provide further health information, on or before the first day of the program. If you have any questions about these agreements, please contact Ben Whalen, Director of Youth Ministry & Community Development, at 262-364-7390 or bwhalen@hoplc.org

Medical Emergency: In the event that my child is injured during a House of Prayer program or event and needs medical care or treatment, we consent to any reasonable medical treatment as deemed necessary by a licensed physician, emergency responder, or health care facility. In the event any medical treatment is called for that a physician, emergency responder, and/or medical treatment facility refuse to administer without parental consent, we hereby authorize a staff or other adult leader associated with House of Prayer Lutheran Church to give such consent for us if we cannot promptly provide such consent in person, by telephone at one of the numbers listed above, or if, because of an emergency, there is not sufficient time or opportunity to so contact us for such consent. In the event it becomes necessary for such person to give consent for us, we agree to hold such person and the Conference free and harmless from and against any and all causes of action, claims, demands, injuries, liabilities, and/or losses in any way arising from, connected with, or related to the giving or not giving of consent, so long as the treatment is administered by or under the supervision of a licensed physician, emergency responder, or medical treatment facility. We also acknowledge that we will be ultimately responsible for the cost of any medical care, whether or not covered, made, or reimbursed by our health insurance carrier or any other third party.

Transportation: I give permission for my child (listed above) to be transported in vehicles owned/operated by staff members or other adult leaders designated by House of Prayer Lutheran Church. I understand that it is my responsibility to inquire in advance of an event or program if I have questions or concerns about transportation arrangements. In the case of an emergency, I give House of Prayer Lutheran Church along with its staff and adult leaders permission to take appropriate action for the safety of my child(ren). I release House of Prayer Lutheran Church, its staff, and adult leaders from liability related to the transportation of my child(ren).

Media Release: I grant permission for House of Prayer Lutheran Church to take pictures and/or videos of my child(ren) during the programs listed above and print/post those for their website, newsletter, social media, and other print or online publications. These images/videos will be used to let the congregation and community know how previous programs and events have gone and for the purpose of promoting future programs and events.

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