First Lutheran of Richmond Beach 2017-2018 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 2017-2018 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
1. 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 T-Shirt Size *
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 2017-2018. 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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