First Parent's/Guardian's Name
First Parent's/Guardian's Name
First Name
Last Name
First Parent's/Guardian's Email Address
*
First Parent's/Guardian's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
First Parent's/Guardian's Cell Phone Number
(###)
###
####
Second Parent's/Guardian's Name
First Name
Last Name
Second Parent's/Guardian's Email Address
Second Parent's/Guardian's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Second Parent's/Guardian's Cell Phone Number
(###)
###
####
Media Release Statement-By agree with the statement below, I, hereby grant, voluntarily and with full understanding, to St. Paul’s Lutheran Church of Millard, a license to the following:
*
1. Use and storage of my (or my child’s) image, by means of digital or film photography, video photography, audio recording, or other documentation, with respect to the activity of the Church for which I am registering. 2. Use of any stored data including my (or my child’s) image in printed publications of the Church. 3. Use of any stored data including my (or my child’s) image in electronic publications or social media accounts of the Church. 4. Use of any stored data including my (or my child’s) image in any Web site created by or for Church. 5. Storage of my (or my child’s) name in association with any image, but not permission to use such images in any public setting unless I specifically authorize Church to do so. 6. If I am entering this agreement on behalf of a minor child, I hereby warrant that I am the legal parent or guardian of the child and that I have the legal authority to enter this agreement on behalf of the child. 7. If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process.
Use of Names
*
I specifically authorize Church to use my (or my child’s) name and image for all the purposes listed above.
I give my student permission to participate in all activities, assume all risk and allow St Paul's to secure medical help if necessary.
*
I'd like to serve in the following ways:
First Child's Name
*
First Name
Last Name
First Child's Birthday
*
MM
DD
YYYY
First Child's Grade
*
6th
7th
8th
9th
10th
11th
12th
I'm registering for the following opportunities:
*
First Child's Allergies/Special Needs
First Child's Cell Phone Number (if applicable)
First Child email address (if applicable)
I give my permission for St. Paul' Faith Formation staff to text or contact my child via social media regarding upcoming events for church.
Second Child's Name
First Name
Last Name
Second Child's Birthday
MM
DD
YYYY
Second Child's Grade
6th
7th
8th
9th
10th
11th
12th
I'm registering for the following opportunities:
Second Child's Allergies/Special Needs
Second Child's Cell Phone Number (if applicable)
Second Child email address (if applicable)
I give my permission to St. Paul's Faith Formation staff to text or contact my child via social media about upcoming events for church.
Third Child's Name
First Name
Last Name
Third Child's Birthday
MM
DD
YYYY
Third Child's Grade
6th
7th
8th
9th
10th
11th
12th
Third Child's Cell Phone Number (if applicable)
Third child email address (if applicable)
I'm registering for the following opportunities:
Third Child's Allergies/Special Needs
I give my student permission to participate in all activities, assume all risk and allow St Paul's to secure medical help if necessary.
Fourth Child's Name
First Name
Last Name
Fourth Child's Birthday
MM
DD
YYYY
Fourth Child's Grade
6th
7th
8th
9th
10th
11th
12th
Fourth Child's Cell Phone Number (if applicable)
Fourth child email address (if applicable)
I'm registering for the following opportunities:
Fourth Child's allergies/Special Needs
I give my student permission to participate in all activities, assume all risk and allow St Paul's to secure medical help if necessary.
