Confirmation Registration – Our Savior’s Lutheran Church

2021-22 Confirmation Registration

STUDENT INFORMATION

Student's First Name

Middle Name

Student's Last Name

Gender

Female

Male

Has the student been baptized?

Yes

Baptism Date

Grade in 2021-22

Student's Email

School Attending

Student's Cell Phone

PARENT INFORMATION

Student Primarily Lives with:

Both Parents

Mother

Father

Grandparent(s)

Legal Guardian

Father's First Name

Father's Last Name

Father's Cell Phone

Father's Email

Mother's First Name

Mother's Last Name

Mother's Cell Phone

Mother's Email

Parent's Address

Address Line 1

Address Line 2

City

State

Zip Code

Father's First Name

Father's Last Name

Father's Cell Phone

Father's Email

Father's Address

Address Line 1

Address Line 2

City

State

Zip Code

Mother's First Name

Mother's Last Name

Mother's Cell Phone

Mother's Email

Mother's Address

Address Line 1

Address Line 2

City

State

Zip Code

Grandparent's First Name

Grandparent's Last Name

Grandparent's Cell Phone

Grandparent's Email

Grandparent's Address

Address Line 1

Address Line 2

City

State

Zip Code

Legal Guardian's First Name

Legal Guardian's Last Name

Legal Guardian's Cell Phone

Legal Guardian's Email

Legal Guardian's Address

Address Line 1

Address Line 2

City

State

Zip Code

EMERGENCY CONTACT INFORMATION

Someone other than a parent or guardian

Emergency Contact's First Name

Emergency Contact's Last Name

Emergency Contact's Cell Phone

Relationship to Student

Grandparent

Family Member

Friend of Family

Other

Medical Information

Does your student have any medical conditions?

Yes

Please describe your student's medical condition

Does your student have any allergies related to: pollen, medications, food, insect bites, etc.?

Yes

Please describe your student's allergies

Should your student's activities be restricted for any reason?

Yes

Please describe your student's activities that should be restricted

PERMISSIONS

The following permissions are for the student registrant(s) named above to attend all youth activities sponsored by Our Savior's Lutheran Church of Albany, MN (hereinafter "the Church") from September 1, 2021 to August 31, 2022.

Occasionally we take pictures during church activities. We would like your permission to use pictures and video of your child on our website and social media sites, in our newsletter, and/or on our bulletin boards. Pictures and videos would be selected to highlight the activities of the church. We will never reference your child by name or provide any specific information regarding your child. The pictures will only be used by the church to show the many ways our youth are living out their faith, and having fun doing it.

YES, I grant permission to use pictures and/or videos of my student on the Church website, social media sites, newsletter and/or bulletin boards.

NO, Please do NOT take or use any photos or videos of my student.

Medical Attention

YES, I give permission to seek whatever medical attention is deemed necessary, and release the Church, its staff, and volunteers of any liability against personal losses of named student registrant.

NO, I do NOT give the Church permission to seek any medical attention for the named student registrant.

EXPECTATIONS

The following are expectations of the Confirmation program:

Respect one another, staff, and adult leaders
Respect property
Respect and comply with event schedules
Participation with the group is expected
No possession or use of alcohol, drugs, or tobacco
No students will drive during youth activities
No fighting, weapons, fireworks, lighters, or explosives
No offensive clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters

Failure to comply with these expectations will lead to removal from the confirmation program.

I have read and understand the expectations of the Confirmation program

Yes

CONSENT

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/We hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our student's involvement. In the event that he/she is injured and requires the attention of a doctor, I/We consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/We agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/We affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/We also agree to bring my/our student home at my/our own expense should they become ill or if deemed necessary by a church staff member.

By typing your name below, you are acknowledging and consenting to the above consent and will allow your student(s) to participate in the Confirmation Program at Our Savior's Lutheran Church in Albany, MN.