High School Registration 2023-2024

To participate in our exciting High School activities (including online only opportunities!), all youth must fill out our online registration form. Luckily--you need to fill out this registration form just once a year! Register now for all High School Activities for the 2023-2024 Program Year. Once you are registered, you WILL NOT receive a confirmation email. If you have any questions, please email Danielle at youth@hslckirkland.org.

Youth Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Grade in Fall

Gender

Student Email Address

Student Cell Phone

(###)

###

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It is imperative when working with your child that we are aware of any special needs/challenges that they face. This information is kept confidential and is accessed by leaders only.

Family Email Address

Home Phone Number

(###)

###

####

Parent/Guardian 1

First Name

Last Name

Parent/Gardian 1 Cell Phone

(###)

###

####

Parent/Gardian 2

First Name

Last Name

Parent/Guardian 2 Cell Phone

(###)

###

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Emergency Contact (other than parents)

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Health Insurance Company

Policy Number

Regular Medications

Allergies (food, drug, etc)

I give my permission for my child to participate in these activities which will be led by Safe Haven trained adults. Please select all that apply.

Youth Group, Confirmation, Devotions with Danielle, and other activities held at the church

Activities outside the church. Your child may ride in a church vehicle or in a personal vehicle of a Safe Haven approved adult

I give my permission to Holy Spirit Lutheran church to use photographs and videos of my child in public displays, media releases and social media. I understand these photographs will not be sold or used for commercial purposes.

I hereby release Holy Spirit Lutheran Church and its representatives from all liability in the event of an injury during any HSLC activity through August 31st, 2024. If I am not readily available I, as legal parent or guardian, authorize and consent to all medical, surgical, and diagnostic and hospital procedures as may be performed or prescribed by a physician. Such treatment will only be administered when advisable by a physician to safeguard my child’s health. It is understood that every effort will be made to contact the undersigned prior to rendering treatment, but that any of the above treatment will not be withheld if the undersigned cannot be reached.

Please write your name below