Confirmation Registration
Please fill out this form and click submit.
Youth Information
Youths Name
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Grade (Fall 2023)
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Please select one option.
7th Grade
8th Grade
Select Option
7th Grade
8th Grade
School
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Youth's Phone Number (if they have one)
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Do staff have permission to text your child periodically to send out information and reminders?
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Please select all that apply.
Yes
No
Any Allergies or Special Considerations?
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Please select one option.
Yes
No
If you chose yes, please explain:
Anything that you would like us to know about your child that will help us to better serve them?
Parent/Guardian Contact Information
Parent/Guardian Name
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Parent/Guardian Phone
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Parent/Guardian Email
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This address will receive a confirmation email
Parent/Guardian Release Forms
I give permission for the above named member to participate in Diamond Lake Lutheran Church activities and programming. I hereby authorize my child to participate in these activities and hereby release and waive any claim, demand, cause of action or assertion of liability against Diamond Lake Lutheran Church, its pastors, pastoral associates or agents, which may result from any accident or happening occurring during or as a result of such activity. Further, if any emergency medical or surgical administration is needed by my child during or resulting from said activities, I authroize any of the pastors, pastoral associates, staff or agents of Diamond Lake Lutheran to authroize any licensed physician or surgeon to administer any such emergency medical or surgical attention. I further waive any claim, demand or cause of action of liability against Diamond Lake Lutheran Church, its pastors, pastoral associates or agents, because of such emergency medical or surgical administration. I also understand the Diamond Lake Lutheran's NO TOLERANCE policy. There will be no cigarettes (regardless of age), alcohol, illegal drugs, the disrespecting of another person, unauthorized time away from the group or inappropriate sexual or physical activity allowed on the premises or during youth events. If at anytime a person is caught breaking this policy, they are subject to being sent home at the expense of the parent/guardian of this youth.
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Please select all that apply.
Yes, I give permission
No, I do not give permission
I hereby grant Diamond Lake Lutheran Church permission to use my likeness in photographs, video recordings or electronic images in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the organization and will not be returned. I hereby irrevocably authorize the organization to edit, alter, copy, exhibit, publish or distribute these images for purposes of publicizing the organization's programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image. I hereby hold harmless and release and forever discharge the organization from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 18 years of age and am competent to contract in my own name, or if I am under age 18, a parent or guardian has approved. I have read this release before clicking
*
Please select all that apply.
Yes
No
Submit
Description
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