Youth Music & Creative Arts Registration Form
 
Youth Music & Creative Arts Registration Form
Name  * 
Age  * 
Grade (Fall 2015)  * 
Student's cell phone (if applicable)
Texts ok?
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  * 
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  * 
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.  * 
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.  * 
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.  * 
I hereby waive and release Mission Lutheran Church, the staff and volunteers from all liabilities for injuries or illnesses incurred during activities/outings.  * 
Photo Release Authorization
Use a picture of your child participating in church related activities on our communication materials, including website, social media, brochures, etc.  * 
Use a picture of your child within the confines of the church, such as bulletin boards, etc.  * 
Expectations and Guidelines
Follow directions of leadership  * 
Demonstrate appropriate behavior  * 
Be respectful of church property and the property of others  * 
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 $
 
 
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