Youth Music & Creative Arts Registration Form
Name
*
Age
*
Grade (Fall 2015)
*
Student's cell phone (if applicable)
Texts ok?
No
Yes
Students email (if applicable)
Birthdate
*
Special needs or allergies
Parents Name
*
Cell Phone
*
Address
*
Your Email Address
*
Emergency contact name
*
Phone number
*
T-shirt size
*
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
Adult XL
Please choose the group that your child will participate in. All groups begin Wednesday, Sept. 16 in the Music Room.
Sing & Shout Club (Pre-K - K), Wednesday afternoons 3:30 4:00 (limited to first 15 registrations)
Kids of the Kingdom (1st - 6th grade) Wednesday afternoons 4:30 - 5:30 (minimum # of students required for class to be held is 6)
Youth Worship Arts (7th - 12th grade) Wednesday evenings 6:00 - 7:00
Programs
*
Sing & Shout Club (Add $35.00)
Kidz Praise (Add $35.00)
Kids of the Kingdom (Add $35.00)
Youth Worship Arts (Add $35.00)
Permission Slip, Medical Consent & General Release
I hereby give permission for my child to participate and I have listed any physical impairments that would affect my child's participation.
*
No
Yes
I authorize Mission Lutheran Church, its staff members or volunteers to act for me according to their best judgment in any emergency requiring medical attention.
*
No
Yes
If yes, please list any medical condition(s) that we should know about.
I hereby give consent for any and all medical treatment deemed appropriate and necessary by the attending medical professional.
*
No
Yes
I hereby waive and release Mission Lutheran Church, the staff and volunteers from all liabilities for injuries or illnesses incurred during activities/outings.
*
No
Yes
Photo Release Authorization
Use a picture of your child participating in church related activities on our communication materials, including website, social media, brochures, etc.
*
No
Yes
Use a picture of your child within the confines of the church, such as bulletin boards, etc.
*
No
Yes
Expectations and Guidelines
Follow directions of leadership
*
No
Yes
Demonstrate appropriate behavior
*
No
Yes
Be respectful of church property and the property of others
*
No
Yes
Our goal is for all to have a fun & positive experience. Should your child choose to not follow the above guidelines, you will be contacted and appropriate action will be taken.
Total
$
Online Giving
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