2011-12 Sunday School Registration

Child's Name: Nickname:

Parent(s) or Guardian(s) Name(s):

Child's Birthdate: Grade in School:

Address: Phone:

Email:

Allergies or other conditions we should be aware of (food reactions, physical limitations, etc.):

Emergency Contact Name and Phone Number:

I am available to help (check all that apply):

As a substitute teacher

As a parent helper in the classroom

With large group events

Comments:

Release

I, the undersigned parent or guardian, do hereby authorize emergency medical, dental, health, or hospital services be rendered to my child upon consent of a St. Matthew staff member or designated volunteer. The purpose of this authorization is to permit my child to receive emergency medical attention when needed while involved in the activities connected with St. Matthew when I or an emergency contact is unavailable to give such consent. The authorization shall be effective from September 2010 to May 2011.

Placing your initials in the box serves as an electronic signature:

Permission for Photographing your Child

We would like to take pictures during Sunday School and other events/activities at St. Matthew Lutheran Church. In order to do this, we need your permission to use these pictures on the church website, displays and bulletin boards, or in our newsletter. We will not reference your child by name or provide specific information regarding your child. We also will never sell these pictures; we will use them exclusively for St. Matthew’s purposes.

Yes, I grant you permission to use photos of my child on St. Matthew’s website, displays or bulletin boards, and/or in newsletters.

No, please do NOT take or use any photographs of my child.

Placing your initials in the box serves as an electronic signature: