Love God Love Neighbor Sign-Up 2024-25
Please fill out this form and click submit.
SECOND SUNDAY SEPT - APRIL 2024-25
12:00 - 2:45 PM
6TH GRADE AND UP...
Youth Information
Youth Name
*
Parent name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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Emergency Contact #1
*
Emergency Contact #2
*
Allergies and Medical Conditions
List any allergies
*
Any medical conditions?
*
Prescription and non-prescription medications
*
Insurance Information
Insurance policy holder if applicable and relation to youth
*
Insurance company
*
Policy/Group Number
*
Family Doctor and Phone
*
Chaperone Information
Please complete if the youth is attending LGLN events with an adult other than their parent/legal guardian.
Chaperone Name
*
Phone
*
Relationship to youth
*
I given permission for photos, video, and electronic images to be taken of me or my child and used for by the Church for promotional purposes without compensation, inspection or approval.
*
Please select all that apply.
Yes, I give permission
No, I do not give permission
I, parent/guardian of the above named youth, consent to my child participating in the Love God Love Neighbor events organized by the St. Luke Evangelical Lutheran Church from Sept. 8, 2024-May 30, 2025. I agree that my child's participation in Love God Love Neighbor is purely voluntary. I agree not to hold the Church liable or responsible for any loss or injury sustained by my child arising in connection with his/her participation in Love God Love Neighbor. In the event treatment is called for in which a physician (or hospital personnel) is needed, I authorize adult leaders, volunteer or paid, to give such consent for all necessary medical treatment if we cannot be reached or if because of an emergency. Should medical help be needed, I agree to pay either directly and/or through my own health insurance policy all medical or hospital costs and to be solely responsible for said treatment and the cost thereof. I will keep my contact information up to date in charms so I may be contacted as needed.
*
Please select all that apply.
Yes, I give permission
No, I do not give my permission.
Signature
*
Date
*
Submit
Description
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