Children & Youth Event Registration

Student's Name *

First

Last

Which Events Will The Student Attend *

Comments:

Student's School Year *

Student's School

Student's Date Of Birth *

Student's Gender

Guardian's Name/s *

Guardian's Mobile Number/s *

Guardian's Address *

Guardian's Email *

Emergency Contact Name & Number (please ensure we have at least 2 points of contact between Parent's Mobile and Emergency Contact)

Student's Medical Conditions / Needs

Student's Dietary Requirements And/Or Food Allergies

Anything Important We Should Know To Best Care For This Student?

Information Storage Consent (Required) *

I consent to this information being stored by Immanuel Lutheran Church. It will be used only for youth ministry in accordance with the LCAQD Privacy Policy.

First Aid & Indemnity Consent (Required) *

I agree that in the event of a medical emergency where I cannot be contacted that leaders will arrange the best possible medical care. I agree to pay in full for all medical costs involved. I will not hold liable Immanuel Lutheran Church or its agents for any loss or injury incurred.

Photo & Transport Consent (Optional)

I consent to the use of photos of my student for promotional purposes within Immanuel College or Immanuel Church.
I consent to my student being transported by a fully licensed youth leader (only for camps and overnight stay events which involve moving location during the event).

Parent's Full Name in BLOCK LETTERS *

STUDENT COMMITMENT (Required) *

I will respect people and help everyone have a good, safe, and fun time.
If I am disrespectful or make people feel unsafe then I may not be allowed to participate in activities, my parents may be phoned or asked to take me home.
I understand that Immanuel Youth is completely drug and alcohol free.

Student's Full Name in BLOCK LETTERS *

Date *

Immanuel Lutheran Church Buderim