High School Fellowship Registration 2017-2018
Effective Dates: September 1, 2017 — August 31, 2018

This Universal Permission form is intended to cover all the bases, with the assumption that your youth may participate in any activity at Light of Christ or off-site with Light of Christ staff during the 2017-2018 school calendar year.

YOUTH INFORMATION
Youth Name *
Grade *
Date of birth
MM
/
DD
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YYYY
Youth email
Youth Address *
Youth cell
PARENT/GUARDIAN INFORMATION
Parent/guardian #1 *
Parent/guardian #1 email *
Parent/guardian #1 phone *
Parent/guardian #2
Parent/guardian #2 email
Parent/guardian #2 phone
Emergency contact - name, relation, and phone
Parental Consent
I/we hereby release Light of Christ Lutheran Church, its employees, agents and volunteers, from any and all liability, claims, demands, causes of action and possible causes of action whatsoever arising out of or related to any loss, damage or injury (including death) that may be sustained by my youth while participating in or traveling to and from an event at Light of Christ.

I/we understand that personal injury can and may occur to my child, and I hereby authorize a representative of Light of Christ Lutheran Church to seek and consent to emergency medical treatment, dental care, surgery or hospitalization for my child as needed during the period of my/our absence; and I further agree to be liable for and to pay all costs incurred in connection with such medical/dental attention.

EARLY RETURN HOME POLICY: Should it be necessary for my youth to return home due to medical reasons, disciplinary action or otherwise, the I/we shall assume all transportation costs and responsibility.

TRANSPORTATION PERMISSION: I/we also hereby give permission for my youth to ride in any vehicle driven by an approved and licensed adult chaperone while attending and participating in activities sponsored by Light of Christ.

Please type your name and date below if you agree to the terms above *
MEDICAL INFORMATION
Primary Care physician *
Name, phone number, name of practice
Insurance information *
Medical Insurance company, policy/group ID#, and policy holder's name
Medication
List all medications the youth may/will take during any youth ministry trips, retreats, or events. This includes any prescription, non-prescription medications, herbal supplements and vitamins. Any participant under the age of 18 is required to give ALL MEDICATIONS to the adult youth leader in their original containers with complete dispensing instructions before the start of the event. Youth are not permitted to carry any prescription or non-prescription medication and will be sent home at the parent/guardian’s expense if they do. Example: Zyrtec 5mg Seasonal allergies Take one pill daily in the morning with food
Over-the-Counter medication permission
Do you give permission for your youth to be given over-the-counter medication as needed and as directed on the label, to treat non-emergency medical conditions that do not require a doctor or hospital visit such as a minor headache, stomachache, or allergic reaction (i.e. Tylenol, Advil, antacids, Benadryl) while at a youth ministry event?
Medical conditions
1. List any medical conditions you have (asthma, diabetes, epilepsy, etc.). 2. List any allergies (drug/medicine, food, and/or environmental) and the severity and type of reaction. 3. Please explain any other pertinent information about the participant (i.e.physical, behavioral, or emotional) that would be important for the adult leaders to know.
MEDIA RELEASE
Photos *
Do you grant Light of Christ Lutheran Church the right to take photographs in connection with youth education classes, Confirmation evenings, summer programs, and any other Church sponsored event? Do you authorize Light of Christ Lutheran Church to use such photographs for any lawful purpose, including, for example, appearing in print or online promoting Light of Christ’s activities, promotional brochures, worship presentations, or Light of Christ’s Facebook page?
For parents/guardians of High School youth only:
Do you grant permission for church staff and adult volunteers who work directly with youth to use church-sponsored digital communications (group texting or email) to maintain contact with youth members regarding church-sponsored activities?
ADULT MINISTRY TEAM OPPORTUNITIES
God has called parents to be the greatest influence in the faith development of their children. Your involvement in LOC’s Confirmation and High School ministries contributes to its success and fulfills the promises you made at your child’s baptism! Below is a list of opportunities for you to share your gifts. Please prayerfully consider and mark below the ways in which you will support your child during this year of Confirmation and/or High School. We ask every family to find at least one area in which to volunteer each year. Contact Rachel if you have any questions about the details regarding these roles.
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