2025-26 Children & Youth Program Registration/Consent Form

Please complete this 2025-26 Program Registration and Consent Form for your child(ren).

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* 1. Name of Child(ren)

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

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* 2. School Grade (Fall of 2025)

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

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* 3. Birthday and Age

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

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* 4. Street Address, City, State, Zip

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* 5. Parent(s)/Guardian(s) Name and Email Address

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* 6. Parent(s)/Guardian(s) Home and Cell Phone

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* 7. Emergency Contact Name and Contact Number

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* 8. Name and Relationship of Adults Approved to Pick Up your Child(ren)

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* 9. Ministry Participation at Salem (check all programs you're interested in)

Sunday School (3yr-12th Grade)

Children's Faith Milestones (Baptism, First Bible, First Communion, 3rd Grade Bible)

Children's Music Program (Children's Choir, Special Performances, Music Camp, Musicals, Chimes)

Senior High Events and Activites (9th-12th Grade)

Middle School Events and Activities (6th-8th Grade)

Confirmation (Education for 7th-8th Grade Students)

Other (please specify)

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* 10. Medical or Behavioral Concerns (including allergies)

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

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* 11. Current Medications

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

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* 12. Parent/Guardian Consent (check all that apply)

Salem Lutheran Church may publish photos and videos taken of my child(ren) during church activities.

(6th-12th Grade Only) I give permission for my child(ren) to be contacted via cell phone, text, email, and Facebook. I will contact the Salem office if I also wish to be copied on any or all communication.

I will inform staff and volunteer leaders reagarding all allergies and/or medical concerns affecting my child(ren).

I give approved Salem leaders permission to transport my child(ren) to and from events. I understand all approved drivers will require children to be secured by seat belts and will use any child safety restraint system I provide.

I give permission for my child(ren) to fully participate in all programs, activities, and events sponsored by Salem Lutheran Church. I understand that all measures will be taken to contact me in the event of a medical emergency involving my child(ren). If I cannot be reached I give the Salem adult leadership the authority to make decisions in the best interest of my child(ren).

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* 1. Name of Child(ren)

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* 2. School Grade (Fall of 2025)

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* 3. Birthday and Age

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* 4. Street Address, City, State, Zip

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* 5. Parent(s)/Guardian(s) Name and Email Address

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* 6. Parent(s)/Guardian(s) Home and Cell Phone

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* 7. Emergency Contact Name and Contact Number

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* 8. Name and Relationship of Adults Approved to Pick Up your Child(ren)

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* 9. Ministry Participation at Salem (check all programs you're interested in)

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* 10. Medical or Behavioral Concerns (including allergies)

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* 11. Current Medications

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* 12. Parent/Guardian Consent (check all that apply)

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* 13. Parent/Guardian Electronic Signature