Saint Luke Kids- Sunday School Pre-Registration
Health & Liability Waiver
  • Please list your preferred contact person first. This is the parent/gaurdian that will be listed as primary contact.
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  • In Case of Emergency

    When guardian(s) cannot be reached:
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  • Child #1 Information

  • Child #2 Information

  • Child #3 Information


    In consideration of being accepted by Saint Luke Evangelical Lutheran Church for participation in church activities, I (we) do for myself (ourselves) and on behalf of my child/participant do hereby release, forever discharge, and agree to forever hold harmless Saint Luke, the employees, and agents thereof, from any and all liability, claims and demands for personal injury, sickness and death, as well as property damage and expenses of any nature whatsoever which may be incurred by me or my child/participant resulting from said child’s participation in the church sponsored events, including travel, recreation and all associated activities.
    Further, I (we) (and on behalf of our child/participant under 18 years of age) hereby assume all risk of said personal injury, sickness, death, damage and expenses as a result of participation as above set forth. I also understand that staff and volunteers are not responsible for the administration of prescribed medication and I (we) have made private arrangements for any medication taken on a daily schedule by my child/participant. I give permission for the staff and/or volunteers of Saint Luke Church to administer basic first aid as necessary.
    I (we) am (are) the parent(s) or legal guardian(s) of this participant, and herby grant my (our) permission for him/her to participate fully in said events, and give my (our) permission to take said participant to a doctor or hospital, share the above medical information and authorize medical treatment, including, but not limited to emergency surgery or medical treatment, and assume responsibility of all medical bills incurred by my child.
    I (we) also grant Saint Luke Church unrestricted rights to use, alter, and reproduce any images (still and video) from the event, in any medium without compensation.
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