Trinity Youth Faith Formation Form

Trinity Youth Faith Formation Registration

Please fill out the following to register for Sunday School, Confirmation and youth events. You can enroll all your youth on one document!
First Student Name

First Name Middle Name Last Name
First Student's Birth Date

Month Day Year
First Student's Gender
First Student's Grade for 2019-2020 School Year
First Student's Allergies/Special Needs
Is the First Student Baptized?

Yes No I would like to be contacted about baptism
Second Student's Name

First Name Last Name
Second Student's Birth Date

Month Day Year
2nd Student's Gender
Second Student's Grade for 2019-2020 School Year
Second Student's Allergies/Special Needs
Is the Second Student Baptized?

Yes No I would like to be contacted about baptism
Third Student's Name

First Name Last Name
Third Student's Birth Date

Month Day Year
Third Student's Gender
Third Student's Grade for 2019-2020 School Year
Third Student's Allergies/Special Needs
Is the Third Student Baptized?

Yes No I would like to be contacted about baptism
Fourth Student's Name

First Name Last Name
Fourth Student's Birth Date

Month Day Year
4th Student's Gender
Fourth Student's Grade for 2019-2020 School Year
Fourth Child's Allergies/Special Needs
Is the Fourth Student Baptized?

Yes No I would like to be contacted about baptism
First Guardian's Name

First Name Last Name
First Guardian's E-mail Address
First Guardian's Phone Number

Area Code Phone Number

First Guardian's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Second Guardian's Name

First Name Last Name
Second Guardian's Email Address
example@example.com
Second Guardian's Phone Number

Area Code Phone Number

Second Guardian's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Do you have Medical Insurance?
Insurance Company Name
Policy #
Physician Name, Clinic/Hospital
Media Release Statement: By agreeing with the statement below, I, hereby grant, voluntarily and with full understanding, to Trinity Lutheran Church, 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 Church for which I am registering. 2. Use of any stored data including my (or my child’s) image in printed publications of Church. 3. Use of any stored data including my (or my child’s) image in electronic publications or social media accounts of 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. *

Agree Disagree
In consideration for the child being accepted by Trinity Lutheran Church, for participation in youth trips/activities, we, being the parent(s) or legal guardian(s) of the undersigned child, do release and agree to hold harmless Trinity Lutheran Church, Madison and its chaperones, employees, agents, representatives, and board members from any and all liability, claims, damages, or demands for personal injury, as well as damage and expenses (including reasonable attorneys fees), of any nature that may be incurred by the parent/guardian and child/participant while the child is participating in the above described trip or activity or in connection with or resulting from such trip or activity, including transportation to and from the above described trip or activity. *

Agree Disagree
We give our permission to Trinity Lutheran Church to furnish any necessary transportation, food and lodging for the above listed youth and for him/her to participate fully in such trip/activity and give our permission and consent to transportation of the undersigned child to a doctor, hospital, or other medical provider and authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. *

Agree Disagree
I'm interested in serving in ministries with children, youth, and families. *

Yes No
How do you prefer to be contacted for youth events?

Email Text Mail
If you prefer to be texted, what is your phone carrier?
Additional Comments
Should be Empty:

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Trinity Youth Faith Formation Registration