First Lutheran of Richmond Beach 2016-2017 Youth Registration
This online form should be filled out by a parent or guardian of any youth 7th-12th grade wanting to participate in youth group or confirmation for 2016-2017 at First Lutheran of Richmond Beach (FLRB)
Youth First Name
Your answer
Youth Last Name
Your answer
1. Parents /Guardians First and Last Name
Your answer
2. Parents /Guardians First and Last Name
Your answer
1. Parent/Gaurdians Cell Phone
Your answer
2. Parent/Gaurdians Cell Phone
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Family Email
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Youth's Date of Birth
Your answer
Grade
Youth's School
Your answer
Youth's Cell phone number
Your answer
Youth's Email
Your answer
Important Medical Information
Your answer
In order to make this a healthy experience, what joys and concerns would you like to share about your child?
Your answer
Medical authorization must be signed by parent or guardian. My son/daughter has permission to engage in all church activities on and off property for 2016-2017. In the event I cannot be reached in an emergency, I give my permission to the physician selected by my child’s chaperon to secure proper treatment for my child as named above. Please type your name below to give permission.
Your answer
We hereby give permission for First Lutheran Church to photograph our child for in-house pictures, snapshots of parties and special events for publicity. (such as brochures, web page, newsletter and advertisements.) Please type your name below to give permission.
Your answer
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