Redeemer Youth Registration and Permission Form
This authorization is valid from September 1, 2019 - August 31, 2020
Redeemer Lutheran Church, 1545 Chain Bridge Rd, McLean, VA 22101
Contact us at 703-356-3346
Email *
Youth Name *
Grade *
Required
Birth Date *
MM
/
DD
/
YYYY
Baptismal Date
MM
/
DD
/
YYYY
Parent Name(s)
Address
Home Phone
Cell Phone
Best email address(es) to use *
Allergies
Dietary Restrictions
Clear selection
Emergency Contact (name, relationship, phone) *
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 & on social media. *
Permission to text Reminders: I give permission to receive texts from Redeemer Lutheran Church.
Clear selection
What number should we text?
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