Children & Youth Registration 2018.2019
Required registration form for BOLD, ROC, and music ministries at Trinity Lutheran Church, Mount Joy PA
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Birthdate *
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DD
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Child's Grade in School (List "preschool" if not yet in school) *
Your answer
Names of Guardians *
Your answer
Parent Cell Numbers *
Your answer
Emergency Contact (Name, relationship, cell number) *
Your answer
Parent Email (primary) *
Your answer
Parent Email (secondary)
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 (Please describe)
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. *
All children in grades K and under are required to be picked up by a parent or guardian. If your child is in grades 1 and higher, we seek your permission to release them without a parent present. *
Other information we should know about your child:
Your answer
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 an activities with Trinity Lutheran Church. *
By entering your initials below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *
Your answer
Date of completion *
MM
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DD
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