• Child & Youth Registration Form

  • Thank you for your interest in enrolling your child or youth in Messiah's many fellowship and faith formation programs for young people! This form is to be updated at the beginning of each program year and will help us properly serve you and your child or youth. Information will be kept securely on JotForm's HIPAA compliant website as well as privately within Messiah's secure Realm virtual directory and will only be shared with relevant faith formation staff and volunteers, particularly when traveling offsite. Please be sure information is as accurate as possible. Parents or guardians are responsible for updating this information if it changes throughout the program year (i.e. changes to allergies, medical history, emergency contact information).

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  • Parent/ Guardian Information

    Please list your name and contact information and the name and contact information for a second parent/ guardian, if applicable.
  • Emergency Contact Information

    Please list, in order, two persons that we can contact in the event of an emergency. We will call the first person listed first and continue down the list until we have made contact.
  • Healthcare Provider Information

    Please fill out the following information so we can properly assist your child/ youth in case of a medical emergency, particularly if on a trip outside of regular faith formation hours.
  • Medical History

    Please complete the following basic medical information about your child/ youth to help our staff and volunteers keep them healthy and safe.


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  • Permission to Treat, Photo Release and Waiver

  • By signing below, the parent/legal guardian of the above named child/ youth, authorizes the Evangelical Lutheran Church of the Messiah (hereafter Messiah Lutheran Church) staff and/or volunteers and the medical personnel they have selected to consent to any medical/hospital care deemed necessary. The parent/legal guardian further consents to the release of this health history to the emergency room, hospital or doctor’s office providing care. Messiah will endeavor, but is not required, to communicate with the parent/ legal guardian prior to treatment. The undersigned releases Messiah and its staff and/or volunteers from any liability and claims arising from any consent given in good faith and in connections with diagnosis or treatment.

  • By signing below, the parent/legal guardian of the above named child/ youth, authorizes Messiah Lutheran Church and its staff and/or volunteers to utilize appropriate photographic and/or video images of the child/ youth in line with Messiah's SafeChurch policy. The parent/legal guardian understands that neither they nor the child/ youth will receive compensation, should any photograph and/or video of my child be published. The undersigned, as parent/legal guardian of the above named youth, hereby release, forever discharge and agree to hold harmless Messiah Lutheran Church, its staff and/or volunteers from and against any and all kind of liability, claims, demands, lawsuits, and expense of any kind arising from personal injury, sickness, death or property damage of any kind whatsoever which may be incurred or by virtue of the child/ youth’s participation in faith formation, fellowship and other programming at Messiah Lutheran Church. The undersigned certifies they have full authority to sign this Permission to Retreat, Photo Release and Waiver.

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