26-27 Immanuel Lutheran Church      Children and Youth Ministry Registration Form
For students in nursery, Sunday School, Confirmation, Fusion, Velocity, High School Youth Ministry  (2 months- 12th grade) ONE FORM PER FAMILY

Nursery- 2month- 3 years old 
Sunday School- 3k potty trained- 12 grade
Fusion youth group- 3rd-5th grade
Confirmation- 6-8th grade students
Velocity- 6-8th grade youth group
High School- high school students 9-12th grade 
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Family Last Name *
Address (street address, city, state, zip code) *
 Home Phone number (Optional)
Mother's Name (First and Last) *
Mother's Cell number *
Father's name (first and last) *
Father's cell number *
Emergency Contact person, name and phone number (if parents are unavailable) *
Besides mother and father are there any alternate people allowed to pick up from nursery or Sunday School?
Please include first and last name 
 *
Primary email address to be used for information and communication. *
additional email addresses you would like to receive information.
Photos/videos may be used for educational and promotional purposes on publicly distributed printer materials, within Immanuel's facility or online (including our website, facebook and other social media). Understand that global access to the internet does not allow us to control who may access the photos or videos. *Do you give permission for your child (ren) to be photographed/filmed? (no names will attached to any photo/video without consent) *
This consent form gives permission to seek whatever medical attention is deemed necessary and releases Immanuel, its staff, and its volunteers of any liability against personal losses of the named child. I understand that there are inherent risks involved in any ministry or event, and I hereby release Immanuel, its pastors, staff, employees, agents and volunteer workers from any and all liability for any injury, loss or damage to person or property that may occur during the course of the child's involvement. I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by Immanuel, I agree to hold such person free and harmless of any claims, demands and suits for damages arising from the giving of such consent or damage to person or property that may occur during the course the my child's (ren's) involvement, this includes any exposure to any communicable diseases. *Check below that you have read and agree with the above statement. *
I understand that if something changes it is my responsibility to update DCE Heather Vahl of the changes. *
Are there any changes that need to be shared with the church office (for record keeping purposes only) *

In most cases, cell phones and other personal electronics are not needed during Sunday School or onsite youth group activities. If cell phones and/or other electronics are brought to an event, Immanuel and her volunteers are not liable for lost, stolen, or damaged devices or accessories (including cases, chargers, earbuds/headphones, smartwatches, and gaming devices). If electronic devices are needed for a specific event, advance notification will be given. 

Electronics must remain out of sight and on silent/vibrate unless a leader/teacher provides explicit permission for a specific purpose. If a device becomes a distraction or is misused, the leader/teacher may take the device and return it to the student at the end of the event or to the student’s parent/guardian, as appropriate.

Emergency exceptions may be made as needed. In all cases, students should follow the instructions of the event leader/teacher.

If repeated misuse occurs, the leader may require parent involvement and may restrict electronics for future onsite activities.


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