Wednesday FLCTime 2024-2025 • Farmington Lutheran Church

Wednesday FLCTime participant 0

Youth Information

First Name *

Last Name *

Preferred Name *

Preferred Pronouns

Date of Birth *

School Grade (Fall, 2024) *

School Attending *

Has Youth been baptized? *

Youth Primary Street Address *

City *

Zip Code *

Medical Information: Does youth have any allergies, dietary needs to avoid? *

List Known Allergies

Behavior Information: Does student have any behavior issues we should be aware of? *

Please list known behavioral Issues

Best Email Address to get information to family *

In Case of Emergency Contact

Name *

Relationship to Youth *

Emergency Contact Mobile *

Transportation Consent- 4th Grade and Older

I/We authorize our minor child to be driven to Farmington Lutheran Church (FLC) Events by an FLC staff or volunteer who has successfully completed a background check and attended FLC's Safeguarding Children and Youth training. I/We understand my child is expected to follow the directions provided by the driver, staff or volunteer.

Transportation Permission *

Yes

N/A, Youth is in 3rd grade or younger

Photography Consent

I/We hereby grant permission for Farmington Lutheran Church, it's staff, volunteers or representatives to take and use photographs, video and/or digital images of my child for use in publications, social media and/or promotions.

Photo Permission *

Yes

Parent/Guardian Service Opportunities

I would like to help in children, youth and family ministries in this way: *

FLCTime Sunday Guide (training and lessons provided)

FLCTime Sunday Co-Guide (training and lessons provided)

Assist the guide and be support for them

Help lead Sunday morning music (10-15min)

Maybe! What are my options?