Youth Consent and Liability Waiver
This form needs to be completed in order for your child to participate in any youth activities at Shepherd of the Hills Lutheran Church.  If you do not accept the terms of any section, your child will not be able to participate until you speak with the youth leaders.  
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Contact Information
Participant Name *
Gender *
Birthday *
Participant Cell Phone *
Participant Email *
Parent/Guardian Name(s) *
Address *
City *
State *
Zip *
Home Phone *
Parent/Guardian Cell Phone *
Emergency Contacts
The church will attempt to reach one of the people listed below, but if none of these people can be reached, the church personnel have my permission use discretion in securing medical aid in an emergency.  It is understood that neither the church nor the person responsible for obtaining this medical aid will be responsible for the expense incurred.  

Please list names and numbers in the order you wish them to be contacted.  At least one contact must be someone other than a parent or guardian.
Emergency Contact #1 Name *
Relation *
Phone 1 *
Phone 2
Phone 3
Emergency Contact #2 Name *
Please list names and numbers in the order you wish them to be contacted.
Relation *
Phone 1 *
Phone 2
Phone 3
Emergency Contact #3 Name
Please list names and numbers in the order you wish them to be contacted.
Relation
Phone 1
Phone 2
Phone 3
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