Sunday School Registration 2021-22

Parent/Guardian Information

Parent/Guardian Name #1

Parent/Guardian Email #1

This address will receive a confirmation email

Parent/Guardian Phone #1

Parent/Guardian Address #1

Parent/Guardian Name #2

Parent/Guardian Phone #2

Parent/Guardian Address #2 (if different from above)

Student Information

Child Name

Child Birthdate

Bible Presentation

Hope presents Bibles to the following kids in the September 12 service at 9AM. Does your Kindergarten or 3rd/4th grade child need a Bible?

Kindergarten gets—Bedtime Bible Yes No

3rd or 4th Grade gets—Orange Faith Alive Bible Yes No

Emergency Contact Information

Emergency Contact (other than parent/guardian):

Relationship to Child:

Emergency Contact Cell Phone:

Emergency Contact Alternate Phone:

Medical Information

Medical Insurance Company:

Policy Holder's Name:

Policy/Certificate Number:

Physician Name:

Physician Phone:

Does your child have any allergies?

Yes No

If yes, please list and/or explain type of allergies and reaction:

Please list any medications being taken, medical problems, or other pertinent information including physical, mental, or psychological conditions that may require medication, treament or restrictions:

Authorization for Treatment: I hereby authorize the Hope Lutheran Church staff and volunteers to administer medications and first aid as deemed necessary as well as authorize the medical personnel selected by Hope Lutheran Church Staff to provide emergency medical care by medical staff to hospitalize, secure treatment for, order injection, anesthesia, blood transfusions, or surgery, and to release any records necessary for insurance purposes as well as provide or arrange necessary related transportation for the above named participant. This form may be photocopied.

I Agree I DO NOT Agree

Photo Release

Photo Image Release: As a participant in a Hope Lutheran Church event, I give permission and consent to allow photos, and videos, to be taken of the above mentioned individual during the VBS session. I further give consent that any such images or videos may be published in a variety of ways and used to illustrate and promote Hope Lutheran Church.

I Agree I DO NOT Agree

Volunteering

Are you interested in being a Sunday School Teacher for the year?

Yes No

Periodically we need extra help with Sunday School in different areas. Are you willing to help with any of the following on a periodic basis? NOTE: checking a box does not require you to serve it simply helps secure a list of volunteers if a need arises.

Christmas Program Help Substitute Teacher Nursery Attendant Occasional Classroom Assistant Prep with lesson items (art project, cutting things etc) Music Time Give rides to kids who may need ride to Sunday School Help with end of year teacher appreicaiton Interested in serving on the Board of Christian Education

Sunday School Registration 2021-22

Description

Please Fix the Following