Confirmation Registration

Youth Information
Name *
Name
Birthdate *
Birthdate
Grade student will enter in the fall.
Youth Cell
Youth Cell
Permission to send my child text messages
Household Information
Parent/Guardian 1 *
Parent/Guardian 1
Cell
Cell
Parent/Guardian 1
Parent/Guardian 2
Parent/Guardian 2
Cell
Cell
Parent/Guardian 2
Primary Household Address *
Primary Household Address
Permission
I give permission for my child to participate in Lutheran Church of the Good Shepherd activities under the supervision and direction of the Lutheran Church of the Good Shepherd staff and other designated volunteers. I release Lutheran Church of the Good Shepherd from liability should my child be injured in any way while participating in activities, which specifically include, but are not limited to transportation by private vehicles and activities where my child is not physically supervised by Lutheran Church of the Good Shepherd staff. I give permission for leaders to take whatever steps may be necessary to obtain emergency medical care as warrant- ed. These steps may include, but are not limited to, the following: 1. Attempt to contact a parent or guardian 2. Seek medical examination and treatment for injuries or conditions by a medical professional I understand that it is my responsibility to resubmit this form if any changes occur regarding medical insurance or the health of my child, and that any expenses incurred in necessary emergency medical treatment will be paid by the child’s coverage or the family.
Media Release *
I understand that video and/or photographs of my child may be used in Lutheran Church of the Good Shepherd publications, including the website.
Is there anything else that we should know?