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SS & CC Registration & Youth Activities Form & Medical Release

Please complete the Activities Participation and Medical Release.


Activities Participation

I hereby allow my child/children, for whom I am the legal guardian, to attend/participate in youth activities and events sponsored by Evangelical Lutheran Church, Cokato, MN. I hereby agree my child/children may participate in ongoing and upcoming events. I further agree to waive and release any claims I might have on behalf of myself or my child/children for personal injury, property damage, property loss or death. I discharge and release the Evangelical Lutheran Church, its officials, agents, employees, and volunteers from any liability, which might exist because of my child/children’s participation in said events. I also grant permission for the above named child/children to ride in the provided vehicles that will be transporting the participants during said events. I have read this Release and understand its terms. I hereby sign this release voluntarily and with full knowledge of its significance.

 

Medical Release

In the event of an emergency, I grant permission to Evangelical Lutheran Church staff or agents to transport my child/children to a hospital/after hours clinic for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. As the parent/legal guardian, I give full authorization to the Evangelical Lutheran Church staff or agents to secure medical care or treatment for above named youth. This treatment may include assistance from the nearest physician, medical clinic, hospital, trained nurse or EMT in the event of illness or injury that requires immediate medical attention, as to be determined by the event staff. In the event that I cannot be contacted, and an emergency has occurred, I give permission to the treating medical institution and/or medical providers to hospitalize and administer the appropriate treatment deemed medically necessary. I further agree that Evangelical Lutheran Church and its employees and agents will not be held responsible for injuries or damages arising from the provision of any such emergency medical treatment. I understand that as a parent/guardian, I will be responsible for the cost of any service of treatment provided. This authorization shall remain effective until he/she completes this event. I have read this document, I understand its contents, and I agree to its terms.

Name (Required)
 
Email Address (Required)
Sunday School and Confirmation Class Registration and Youth Activities Participation Form, and Medical Release
Confirmation families meet September 13, 2023 at 7 p.m. (grade 7-9) and at September 6, 2023 at 7 p.m. (grade 10) in Fellowship Hall. Sunday School Rally Day is September 10, 2023 at 9 a.m.
INSTRUCTIONS:
Please add one child per form. Indicate whether registration is for Sunday school (pre-K3 through grade 6), and/or for confirmation class (grades 7-10) and/or other youth activities including grades 11-12. Or register online at www.elchome.net. Questions can be directed to Youth Ministry Coordinator Abbey Prudhomme at abbey.jean.nelson@gmail.com (763-213-3029) or Pastor Timothy Wheatley at pastortim77@gmail.com (612-756-4633). Please complete registration(s) by September 10, 2023.
Your Child/Youth's Full Name
Grade
What are you registering for?
Check the option(s) that fits best.
Sunday School
Confirmation
Other Youth Activities
Birthday
Baptized?
If baptized, write in date of baptism.
Allergies or Medical Info
Please list medical concerns and/or allegies.
List any medications.
Emergency Contact
In the event of an emergency, who do we contact? Phone number?
PARENTS/GUARDIANS NAMES
List name and contact information for any additional parent who should receive children's confirmation class or Sunday school information.
Code #
Please check your Relationship Code Number.
1 = Parent
2 = Foster Parent
3 = Grandparent
4 = Non-Custodial Parent
Your Phone Number
Email Address
Address
US Mailing Address
INSURANCE INFORMATION
Provider
Primary Insured
Policy/Group #
Physician Name
Physician's Phone Number
I have read the Activities Participation above and I agree to the Activities Participation.
Please enter your name below to indicate that you understand the Activities Participation.
I have read the Medical Release above and I agree to the Medical Release.
Please enter your name below to indicate that you understand the Medical Release.
ELC Cokato
280 3rd Street SE, PO Box 448, Cokato, MN 55321
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