2026-27 Youth Ministry Registration, Medical Release, and Permission Form

Registration

Student Name

Student Age

Student Birthday (Month/Day/Year)

Student Year in School

Student Pronouns

Student Email

As the student, I want to receive monthly email updates on Confirmation and/or FLY's Ministry Opportunities

Yes No

Student Address

Student T-Shirt Size

Small Medium Large XL 2XL 3XL

Parent/Guardian One Name

Parent/Guardian One Phone Number

I consent to receiving text messages from Faith Lutheran

Yes No

Parent/Guardian One Email

This address will receive a confirmation email

I want to receive monthly email updates on Confirmation and/or FLY's Ministry Opportunities

Yes No

Parent/Guardian Two Name

Parent/Guardian Two Phone Number

I consent to receiving text messages from Faith Lutheran Yes No

Parent/Guardian Two Email

This address will receive a confirmation email

I want to receive monthly email updates on Confirmation and/or FLY's Ministry Opportunities Yes No

Non-Parent Emergency Contact Name

Non-Parent Emergency Contact Phone Number

Medical Insurance Company

Policy Number

Group Number

Physician Name

Physician Office Phone Number

Medical History

Select the areas of concern for your student. If necessary, add more detailed information.

Is your student a

Good swimmer Fair swimmer Non-swimmer

Does your student have allergies?

Pollens Medications Food Insect Bites None

If yes, please describe:

Does your student have any of the following?

Asthma Epilepsy/Seizure Disorder Heart Issues Diabetes Physical Disability ADHD Social Emotional Disorders Other None

If yes, please describe

Date of Last Tetanus Shot

Does you student wear

Contacts Glasses None

Does your student have any social/emotional needs we need to be aware of? Please explain below.

Please list and explain any major illnesses your student experienced in the last year.

Should your student's activity be restricted for any reason? If yes, please explain below.

Student Medication Information

This information will be used while we attend our trips. Please fill out the information below to the best of your ability so that their medication will be distributed safely. It is important that medications come on trips in their original perscription bottles with instructions on how to distribute.

The below questions are required - if your student does NOT take any medication, please put N/A.

What medication(s) will your student need to take while on the Winter Retreat and Service Trips?

Please tell us why your student needs each medication.

When does your student take these medications?

Please give us specific instructions on how you would like us to manage your child's medication while on these trips (ex: do you want us to hold onto the medication? Will the student hold onto the medication? Do we need to remind them to take their meds? Or do we need to take total charge to hold on and administer meds? etc)

Should the need arise, may adult leaders provide your student with Tylenol?

Yes No

Should the need arise, may adult leaders provide your student with Ibuprofen?

Yes No

Permissions for the Year

Please answer the following questions to grant general permissions for your student's time in Confirmation or FLY this year.

I give my student permission to participate in all Faith Lutheran Church youth ministry events during the 2026-2027 school year.

Yes No

I give Faith Lutheran Church and its adult leaders permission to transport my student to and from select youth ministry events.

Yes No

I understand that I may need to provide transportation for my student when required.

Yes No

I grant permission for photos of my student to appear in church publications such as the Dove newsletter, church website, Facebook, and Instagram.

Yes No

In the event of an emergency, I give Faith Lutheran Church permission to bring my student to the nearest hospital for treatment. I understand I will be notified immediately.

Yes No

I grant permission for my student to attend the Synod-Wide Youth Ministry Network Event.

Yes No

I grant permission for my student to attend the Winter Retreat at Camp Wonderland in Salem, WI over the weekend of January 15-17.

Yes No

I understand that at all events there are inherent risks and I will not hold Faith Lutheran Church or its adult leaders accountable if injury occurs.

Yes No

FLY Specific Event Permissions

FLY Students: I grant my student to participate in Slip N Slide Kickball happening at Faith Lutheran Church. Yes No

FLY Students: I grant permission for my student to attend off-site game nights at another parent's home and acknowledge that Deacon Kayla may not be present. Yes No

Student Trip Behavior Covenant

Going on FLY trips is a very formative and important experience! We go on trips to grow in our faith, serve God’s people, experience God’s love, and learn more about our other siblings in Christ. We love going on these trips, but everyone on the team must behave appropriately while we are on these trips. To ensure that we all remember why we go on these trips and the expectations of our students and parents, we ask that everyone reads this covenant and signs it. Signing this covenant means you agree to this covenant.
1. Respect adult leaders and students – this includes property of all trip participants and listening to adult leaders throughout the trip.
2. Students take accountability for their actions.
3. Students can not bring drugs, alcohol, or weapons.
4. Students are respectful of the place we are staying and the people we’re serving which includes any staff on site.
5. Secret Pals, a tradition during our service trips, are meant to encourage each other throughout the week – students need to get gifts but also give an encouraging note with their gift. Gifts that should not be bought or brought on trips includes anything that can be used to cause a prank or destruction (ex: fireworks, fart spray, silly string, etc)
6. We are on this trip to grow in our faith. Students embrace the different ways that we experience faith on the trip – it is going to look different (or maybe similar) to what it looks like at Faith. Students do not cause distractions during the moments or make fun of the ways others are connecting with God.
7. One thing we love about this trip is the ability to connect with others in FLY. Students covenant to embrace this aspect and be inclusive of the whole group.
8. We represent Faith Lutheran Church wherever we go – students are ambassadors of our congregation.

If students’ behavior is in violation of these expectations and are not listening to adult leaders in regards to these things, they will be sent home. Their family will have to cover the cost of the trip home – this includes air fare.

We truly believe in the power of these trips and their importance in our faith journey! Our congregation supports these experiences every year through prayer, donations, and financial support. We also know how much you all love these trips! Let’s partner together to help make them best experience they can be.

Student, please mark that you have read and agree to the above behavior covenant.

Yes

Parent/guardian, I have read and agree to the above behavior covenant.

Yes

Code of Conduct Covenant

The policy of the ELCA Youth Gathering and the mission trip organizations that we go through that all trips are drug and alcohol free. Faith also holds this policy. To ensure that everyone understands the policy, please read through the policy below and sign at the bottom. Both parent(s)/guardian(s) and student(s) must sign.

1. Drugs and alcohol are PROHIBITED on all trips unless they are prescribed by a medical doctor; it is a safety and legality concern. This includes vapes, edibles, and the like.
2. If a student is caught with one of these items or word gets around that they are using these items on the trip, students will be sent home immediately and will not be able to go on future trips. If this is the case, parents of the student(s) using drugs or alcohol will be contacted immediately; parents will need to either pick up their student or fly them back at their own expense.
3. If it is found out after a trip that a student(s) was using items on the trip, those students will not be able to attend future trips. If a future trip is partially or completely paid for, there will be no refunds.
4. We go on trips as a team; teams look after each other and keep each other safe. If a student who is on a trip sees a prohibited item being used or hears of it, student(s) need to notify Kayla and the other adult leaders immediately. It is part of our policy that if you see something you need to say something. This helps hold our team accountable and keeps everyone safe.
5. If multiple occurrences happen regarding this covenant being broken, future trips may be affected. Trips may be cancelled if this conduct occurs frequently.

We love going on mission trips, but these trips are a privilege. Our top concern is the safety and health of our students while we are away. The above policy is in place to help ensure the safety, health and care of all students.

Student(s) and parent(s)/guardian(s), please sign and date below to acknowledge that you have received this policy and understand the consequences if such behavior occurs. This must be signed and turned in in order to go on the trip.

Student, please mark that you have read and agree to the above code of conduct covenant.

Yes

Parent/guardian, please mark that you have read and agree to the above code of conduct covenant.

Yes

Student Signature

I, the student, have read the rules of conduct, the above evaluation of my health, and permissions to participate in Youth Ministry activities. I agree to abibe by the stated personal limitations and rules of conduct.

Record your signature by typing your name below.

Date

Parent Signature

My student has my permission to attend all youth activities sponsored by Confirmation and FLY (Faith Lutheran Youth) from September 1, 2026 through September 1, 2027. By signing this form, I/we as parent(s)/guardian(s) agree to allow my/our child to participate in events held both on and off the campus of Faith Lutheran Church and to participate in overnight events; students will need to confirm they are attending said off-site events prior to the event.

This consent form gives Faith Lutheran Church permission to seek whatever medical attention is deemed necessary and releases the Church and its staff of any liability against personal losses of named child.

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her/them to attend events being organized by Faith Lutheran Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she/they is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by a youth ministry staff member.

Record your signature by typing your name below.

Date

2026-27 Youth Ministry Registration, Medical Release, and Permission Form

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