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Youth Information and Permission Form

Please fill out this form as completely as possible to register your student for Sunday School and youth events at Lord of Life Lutheran Church.

Required fields are marked with a red asterisk (*).

Parent 1
Parent 2
Medical Information

Please indicate whether your child has any of the following medical or educational plans, either at school or home:

If your child has a medical or educational plan, please bring a copy on Rally Day.

First Aid Medication

The following list of over-the-counter medication is available in the Lord of Life Lutheran Church first aid kits.  These are available to treat minor afflictions.  The dosage is determined according to the size/age of child, and the specific direction listed on the medication.  Please indicate whether or not these medications may be given to your child as needed.  

You will be contacted immediately if illness develops or emergency treatment is required.

By registering your student, you acknowledge that your son or daughter may receive treatment as indicated above with aid from designated Lord of Life Lutheran Church staff or volunteer.  If you DO NOT wish  for your child receive treatment in case of an emergency, please check the box below.

By registering your student, you acknowledge that Lord of Life Lutheran Church may take pictures and/or video of your child which may be used within the building or in publicity materials - including but not limited to the website and Facebook page. Your child will not be identified by name.

By registering your student, you give permission for your son or daughter to be transported by a licensed adult (21+) chaperone to and from any scheduled events.  If you DO NOT wish your student to be transported by another adult, please check the box below.

By typing your full name below, you are indicating that the above information is accurate and you are registering your student to participate in the indicated events at Lord of Life Lutheran Church.