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Valleyfair Registration (Cost: $30.00)
Name
Grade
Phone
Parent Email
Emergency Contact
Emergency Phone
Parent/Guardian Insurance Co
Policy #




In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give Central Lutheran permission to act in my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary by Central Lutheran staff & volunteers. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I absolve Central Lutheran from liability in acting on my behalf in this regard.

I understand that videotapes and/or photography taken of my son or daughter during the retreat may be used for promotion of Central Lutheran's Youth Ministry and therefore give my consent. (By registering you are in agreement with the above statement.)


 
Ministry Staff:
Ryan Braley, Middle School Director

Office:
(763) 441-2363 ext 227

 

Central Lutheran Church, 1103 School Street, Elk River, MN, USA - (763) 441-2363 OFFICE - (763) 441-0010 FAX - webmaster@clcelkriver.org