BLAST Registration Form 2024-2025

Join us on our private Facebook page!

Visit our website at splctx.com

Student Information

Student’s Name*

First NameLast Name

Birth Date*

MonthDayYear

Grade:*

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name*

First NameLast Name

Home Number*

Cell Number*

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name (Different from Parent Above)*

First NameLast Name

Emergency Contact's Relationship to Student:

Emergency Contact's Number*

Alt. Phone Number

Does the student have any allergies (food or contact allergies), chronic illness, or medical conditions? If yes, please describe.

Is the student prescribed an inhaler? If yes, please explain any instructions.

Parent involvement is key to continuing faith development in youth and youth ministry. PLEASE choose at least one way you are able to support this ministry.

Be a member of the Youth & Education Team (meet once a month to plan & give input)Help lead, assist or sub in a BLAST class or help with special eventsHelp with the Christmas ProgramDonate $25 to help with Wednesday night mealsBe an adult chaperone for trips.Help with fundraisers for summer trips and activities.Lead or assist with an Adult gathering during BLAST for parents.Other

Is your child interested in serving as an acolyte during worship for St. Paul Lutheran Church? (For students entering 3rd grade up to 8th grade)

Students interested in serving as an acolyte will be trained and put on the acolyte schedule. It is a wonderful way to learn more about worship and to be an active part of worship.

Is your youth interested in serving as an usher, reader, audio/visual tech. during worship service? (Youth in 7th grade to 12th grade)

Students interested in serving in worship as an usher, reader, or audio/visual tech. will be given instruction, training, and practice so they fell comfortable serving.

Informed Consent and Acknowledgement

The St. Paul Youth leaders and representatives of St. Paul Lutheran Church, Columbus take our responsibility for the physical, emotional, and spiritual well-being of the youth under our care and supervision seriously. In that regard, we will do our utmost to provide your child with a safe and fun setting to participate in St. Paul Lutheran youth activities.

The parent/guardian recognizes and affirms that youth group activities may be hazardous and include, but are not limited to: physical games and activities, sporting activities, and transportation to events. The parent/guardian recognizes that their child prarticipates in such activities at their own risk, that they voluntarily assume those risks, and that they are fully familiar with all inherent dangers.

By signing this form, that parent/guardian releases all youth leaders and /or any members of St. Paul Lutheran Church, Columbus from any liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses of any nature whatsoever as a result of participation in activities. In case of emergency, every effort will be made to contact the parent/guardian.

By signing this form, that parent/guardian grants permission for the participant to participate fully in St. Paul Lutheran Youth activities. In case of injury or medical emergency, the parent/guardian grants permission for the participant to be taken to a licesnsed medical professional and consent to any necessary medical treatment, and assume the responsibility for all associated medical bills. If it is necessary for the participant to return home due to medical reasons or disciplinary action, the parent/guardian assumes responsibilty for all transportation costs.

Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to St. Paul Lutheran Church and its affiliates including youth leaders, teachers, assistants and onsite parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

PHOTO RELEASE: Social media is a great way to share our students activities, events and learning experiences with our church community. Please select an option below to grant us permission to use photographs and videos of your child on our private Facebook page. *

I GRANT St. Paul Lutheran Church permission to use photographs and videos of my child on their private Facebook group, website or to be published in the local newspaper to share with the community how God is working in the lives of children.I DO NOT GRANT St. Paul Lutheran Church permission to use photographs and videos of my child on their private Facebook group, website or in the local newspaper.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

St. Paul Lutheran Church Wednesday Night BLAST Registration