This registration form can be used for Children's Rotational Sunday School (Grades PreK-5), Confirmation (Grades 6th-8th) and Senior High Bible Study (Grades 9th-12th) and Children and Youth Events.

Personal and Contact Information

Participant #1

Name of Participant #1

Age

Birthdate (00/00/00)

Sex

Male

Female

Year in School 2011-2012

Cell Phone (of this individual)

Christ the King, teachers and leaders, may contact this individual by text message.

1. Does this child have allergies to

Please specify

Does this child suffer from, or has ever experienced, or is being treated currently for any of the following

Please specify

Date of last tetanus shot (month/year)

If you have only one child or youth to register, proceed to "General Information". If you would like to enroll more members of your family please complete ALL required information for each participant. A new form will need to be completed for more than 3 participants. (Adults, please use the "Adult Registration Form". A link is provided on our website.)

Participant #2

Name of Participant #2

Age

Birthdate (00/00/00)

Sex

Male

Female

Year in School 2011-2012 (if student)

Cell Phone (of this individual)

Christ the King, teachers and leaders, may contact this individual by text message.

1. Does this child have allergies to

Please specify

Does this child suffer from, or has ever experienced, or is being treated currently for any of the following

Please specify

Date of last tetanus shot (month/year)

Participant #3

Name of Participant #3

Age

Birthdate (00/00/00)

Sex

Male

Female

Year in School 2011-2012 (if student)

Cell Phone (of this individual)

Christ the King, teachers and leaders, may contact this individual by text message.

1. Does this child have allergies to

Please specify

Does this child suffer from, or has ever experienced, or is being treated currently for any of the following

Please specify

Date of last tetanus shot (month/year)

General Information

Primary Email Address

Additional Email (If you would like information sent to more than one email)

Street Address

City

State

Zip

First Parent's/Guardian's Name (Adults may enter n/a or may include name of spouse)

Cell Phone (Include Area Code)

Christ the King, teachers and leaders, may contact me by text message.

Home Phone (Include Area Code)

Work Phone (Include Area Code)

Second Parent's/Guardian's Name (if applicable.)

Cell Phone (Include Area Code)

Home Phone (Include Area Code)

Work Phone (Include Area Code)

Emergency and Medical Information (Must have at least one emergency contact and minors must have two emergency contacts.)

Medical Insurance Company

Policy #

Emergency Contact #1 Name

Home Phone (Include Area Code)

Cell Phone (Include Area Code)

Emergency Contact #2 Name

Home Phone (Include Area Code)

Cell Phone (Include Area Code)

Physician's Name and Phone Number (Include Area Code)

Dentist's Name and Phone Number (Include Area Code)

Permission and Consent

Submission of this consent form, by a parent or guardian of an individual child or children, gives permission to Christ the King Lutheran, its staff and agents to seek whatever medical attention is deemed necessary, and releases the church and its staff of any liability against personal losses of named individual or child.

I understand and I agree

I do not agree

Name of person giving or denying consent. (If under 21, consent must be given by parent/guardian)

Date (00/00/00)

I agree or I, the legal parent/guardian of the above child/children, do hereby agree to appear or have my child/children appear in photographs, videos and/or recordings of Christ the King Lutheran Church activities and agree to have my child's/children's likeness used by the church and its agents for the purpose of public relations, advertising and general publicity for the church including, but not limited to digital, video and audio reproduction of my or his/her likeness.

I give my consent.

I do not give my consent.

Name of person giving or denying consent.

Date (00/00/00)

Gspl Txt Ministry

I would like to be included, and/or have my child included, in the Gspl Tst Ministry.

Note: Text messages are sent by the Youth and Family Minister on weekday evenings at 8:30PM and on other occasions when the need arises. These messages contain a Bible quote or another quote with references to scripture. Prayer requests are also available and will be sent to the entire group (includes adults and children in several states). Please make sure to include the name of any family member who would like to be included in this ministry, their cell number and the service provider--i.e. AT & T, Verizon, etc.

Family Member's Name Cell Number Provider

Getting Involved

The effectiveness any ministry is dependent upon the involvement of the congregation. Please consider giving of your time and talents.

I would like to . . .
Choose as many as you like.

If we haven't list your gift, please describe.

Please type what you see below.
captcha

If you have a child in Confirmation, we are asking each family to donate a $60 per each child who attends Confirmation class.

Or, if you do not have any children in Confirmation, but would like to donate to help defer the cost of materials and events, please click on the button provided. You will be taken to PayPal, where you will be able to pay Confirmation fees or make a donation by credit card. You are always welcome to bring a check into the church office or give to the Director of Youth and Family.

Please enter the total amount you will be paying/donating today, if applicable. (You will then be directed to PayPal.)

Indicates Response Required

none	pollens	medications
food	insect bites	other

none	asthma
frequently upset stomach	epilepsy/seizure
heart trouble	physical handicap
diabetes	other

none	pollens	medications
food	insect bites	other

none	asthma
frequently upset stomach	epilepsy/seizure
heart trouble	physical handicap
diabetes	other

none	pollens	medications
food	insect bites	other

be a Sunday School Rotational Sunday School Teacher (Grades PreK-5th).	be a Sunday School Shepherd (Grades PreK-4th).
help by baking on occasion.	be a Confirmation Guide.
help with administrative or office tasks.	use my carpentry skills or handyperson skills.
sew.	be a Sunday School/Confirmation snack coordinator for Sunday mornings.
help with art projects, computer graphics or marketing.	teach the high school Bible class on occasion.
participate in drama productions, dramatic presentations or readings.	play an instrument.
play in the "King's Ringers" bell choir (7th grade-adults).	play in "King's Chimmers" (2nd-6th grades)).
offer my gifts as a soloist. (either instrumental or vocal)	sing in the adult choir, "King's Choir" (grade 7th through adult).
sing in the children's choir, "Cherubs" (grades preschool-2nd grade).	sing in the youth choir, "King's Kids" (grades 3rd-6th)
participate in the 5th/6th Grade Youth group.	participate in the 7th/8th Grade Youth Group.
participate in the Senior High Youth Group.	act as a 5th/6th Grade Youth Group Coordinator/Leader.
act as a 7th/8th Grade Youth Group Coordinator/Leader.	enjoy the fellowship of the Young Adults Group (ages 21-29)
enjoy the fellowship of Single Adults. (ages 30 plus)	You haven't listed the gift I would like to share. I would like to . . .