Children/Youth Ministry Registration 2023-2024

Child's First and Last Name *

Birth Date *

Grade *

Gender? *

2nd Child First and Last Name

Birth Date

Grade

Gender?

3rd Child First and Last Name

Birth Date

Grade

Gender?

4th Child First and Last Name

Birth Date

Grade

Gender?

Street Address *

City *

State *

Zip Code *

Home Phone *

Main email for Family *

Mother Last Name *

Mother's First Name *

Mother's Work or Cell Phone *

Mother's email

Father's Last Name *

Father's First Name *

Father's Work or Cell Phone *

Father's email

Click HERE For Additional Information About Programming

Education is offered at both sites. Please check all that apply for your family.

	Gilbert	Tempe
Littlest Lutherans (Parent and children under the age of 3)	Gilbert	Tempe
Education (ages 3 - High school)	Gilbert	Tempe

What activities will your family participate in? Please check all that apply. See the program info for dates/times/locations.

	Check if planning on attending.
Joyful Noises (Wednesday Parent/tot class)	Check if planning on attending.
Kids Connect (ages K-5th Grade)	Check if planning on attending.
Confirmation (6th-8th grade)	Check if planning on attending.
Jr. High Night (6th-8th grade)	Check if planning on attending.
High School Night	Check if planning on attending.

We love having families in worship...now we want you to be a PART of worship. Families and children are invited and encouraged to serve as ushers, greeters, lectors, and prayer and song leaders. Check what areas your family (or an individual in your family) is interested in and we will get back with you! Questions? Contact Tempe: Art Krzyzewski at krzyarty@cox.net or Gilbert: Sharyn Jennings sharynnj@cox.net

	Greeter	Usher	Lector	Prayer or Litany Leader	Song Leader	Power Point/Tech
Tempe and Gilbert	Greeter	Usher	Lector	Prayer or Litany Leader	Song Leader	Power Point/Tech

I agree to the use of images of my children, including reproduction of photos, video, or audio by Desert Cross for promotion purposes.

By checking Yes, you are agreeing to the terms listed above. Checking Yes acts as your electronic signature. *

Yes

No, please explain... No, please explain...

Emergency Contact Information

Please fill out every blank, if you need to type: NONE. *

	Alternate Contact #1	Alternate Contact #2
Relation to Youth	Alternate Contact #1	Alternate Contact #2
Name	Alternate Contact #1	Alternate Contact #2
Phone Number	Alternate Contact #1	Alternate Contact #2

Health Information

Pre-existing or present medical conditions or routine medication taken (Please list here with specific child's name)

Allergies? (Please list here with specific child's names)

I hereby release Desert Cross Lutheran Church, its staff and sponsors from responsibility and liabililty for any illness or injury that the above named child may sustain during any activity. In the event of an emergency, I hereby authorize an adult leader of the activity, as agent for me, to consent to any X-ray examination, medical, dental, anesthetic, or surgical diagnosis, treatment, and hospital care advised and supervised by a licensed physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are to be rendered, either at the physician's office or in the hospital. I understand the activity director will endeavor to reach us should the nature of the injury or illness warrant it. However, we will not hold any of the activity personnel responsible if efforts to contact me (us) are unseccessful.

Please note that Desert Cross is taking precautions to prevent the spread of Covid-19 in it's ministry programs, but we cannot guarantee that everyone participating in the program is free from the virus.

*The information provided will be reviewed by the Parish Nurse and shared with adults having contact with this child. Please call the church at 480.730.8600 if you have questions.

By checking Yes, you are agreeing to the terms listed above. Checking Yes acts as your electronic signature. *

Yes

No

Today's Date *