Grace Lutheran Mora 2022-23 Confirmation Registration

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Please complete this form in full for the 2022-23 Confirmation program year. A registration fee of $20 per family is requested to help cover the cost of materials and curriculum.

Important! Please request to join the private FACEBOOK group. "Grace Lutheran Children Youth and Family AND sign up for REMIND by texting:

for 7th grade "@7thgrglc"

for 8th grade "@8thgrglc"

and for 9th grade "@9thgrglc" to 81010.

Both of these will be used for program information and updates. Contact Kelly Kehr with questions. kellykehr01@gmail.com or 320-679-8028

Student's Name *

Date of Birth *

grade *

7th

8th

9th

Student Cell phone number

Mailing Address *

Date and place of Baptism

Parent/guardian name(s) *

Parent/guardian best contact #(s) *

Parent/guardian best email address(es) *

Emergency Contact name and relationship to student *

Emergency Contact best phone number *

Allergies/current medications/other important medical information

Physician name *

Clinic/Hospital used *

Insurance company name and website *

Insurance ID# *

Please read carefully and check the following boxes *

I herby give permission for my child to participate in Children, Youth and Family activities and for them to ride in a volunteer/staff/church vehicle for activities that require transportation.

In the event of an emergency and if I cannot be reached, I also authorize a representative from Grace Lutheran Church Mora to retain or acquire medical care and treatment on behalf of my child. I authorize any hospital, clinic, physician, nurse or technician to furnish my child with any medical care and treatment necessary.

I hearby release and hold harmless Grace Lutheran Church Mora, it's staff, it's council, it's' volunteers as well as staff and volunteers of all assisting groups and vendors, from any and all liability arising from my child's participation in these events.

Photos of my child MAY be taken and used within church publications, websiteand social media.

By checking the above I understand that I am agreeing to the specified terms.

Required

What is it that you want your child to gain during their time in Confirmation?

Submit

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