Redeemer Youth Registration and Permission Form
This authorization is valid from August 26, 2018 - August 31, 2019
Redeemer Lutheran Church, 1545 Chain Bridge Rd, McLean, VA 22101
Contact us at 703-356-3346
Email address *
Youth Name *
Your answer
Grade
Birth Date
MM
/
DD
/
YYYY
Baptismal Date
MM
/
DD
/
YYYY
Parent Name(s)
Your answer
Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Best email address(es) to use *
Your answer
Allergies
Your answer
Dietary Restrictions
Emergency Contact (name, relationship, phone)
Your answer
Permission to participate in youth activities: I hereby grant permission for my child to participate in Redeemer Youth Ministry activities under the supervision of adult chaperones. I understand my child may engage in physical activities with risk of injury. *
Required
Permission for Emergency Medical Treatment: In the event that I cannot give authorization in person, I hereby authorize an adult chaperone from Redeemer Lutheran Church to seek emergency medical treatment for my child.
Permission for Photography: I give permission for my child's picture to be placed on Redeemer's website.
Permission to text Reminders: I give permission to receive texts from Redeemer Lutheran Church.
What number should we text?
Your answer
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