This form is for all Youth Group activities and Sunday School for 2019-20 for youth 6th -12th grade.
To register your child(ren) 3 years through 5th grade, registration form, please click here.

If you have any questions, please contact Andrea Roche.

    Please fill out one form per family for all youth 6th - 12th grades.

    Parent/Guardian Name*

    Primary Family Email*

    Cell Phone*

    By entering your cell phone number, you agree to receive group texts concerning Youth Ministry at Cross of Life. You can opt out of these texts at anytime.

    Home Phone

    Home Address

    Second Parent/Guardian Name

    Other Email

    Other Cell Phone

    By entering your cell phone number, you agree to receive group texts concerning Youth Ministry at Cross of Life. You can opt out of these texts at anytime.

    Emergency Contact Name*

    Emergency Contact Number*

    First Child's Name*

    First Child's Birthdate*

    First Child's Grade

    6th7th8th9th10th11th12th

    First Child's Current School

    First Child's Baptism Date (Please guess if unknown)

    First Child's Cell Phone

    By entering your cell phone number, you agree to receive group texts concerning Youth Ministry at Cross of Life. You can opt out of these texts at anytime.

    First Child's Dietary Restrictions and Severe Allergies

    Second Child's Name

    Second Child's Birthdate

    Second Child's Grade

    6th7th8th9th10th11th12th

    Second Child's Current School

    Second Child's Baptism Date (Please guess if unknown)

    Second Child's Cell Phone

    By entering your cell phone number, you agree to receive group texts concerning Youth Ministry at Cross of Life. You can opt out of these texts at anytime.

    Second Child's Dietary Restrictions and Severe Allergies

    Third Child's Name

    Third Child's Birthdate

    Third Child's Grade

    6th7th8th9th10th11th12th

    Third Child's Current School

    Third Child's Baptism Date (Please guess if unknown)

    Third Child's Cell Phone

    By entering your cell phone number, you agree to receive group texts concerning Youth Ministry at Cross of Life. You can opt out of these texts at anytime.

    Third Child's Dietary Restrictions and Severe Allergies

    If you are unavailable, who else is authorized to pick up your child from Youth Group Events? We recommend listing a trusted COL friend or two. (Must be over 18.)

    Adult Volunteer Opportunities: Check all that apply.

    Health Insurance Information for all 2019-20 Youth Group Events (on and off of Cross of Life's Campus).
    In order to help us take the best care of your child, please complete thoroughly. This form is confidential, and the information provided will only be used appropriately as needed by adult leaders.

    Name on health insurance

    Employer (if applicable)

    Insurance Company

    Group or Plan #

    Member ID #

    Insurance Company Address

    Insurance Company Phone

    Health History: Please list any known physical conditions of your youth of which the adult leaders should be aware (i.e., sleepwalking, recent injury, epilepsy, surgeries, etc.)

    Do and of your youth have any emotional or social adjustment issues which the staff should be aware of in order to provide the best care possible and to facilitate his or her participation in the group? If yes, please explain.

    Have any of your youth ever required psychiatric counseling or hospitalization for mental or emotional health issues which could lead to violence, high anxiety, or in any other way affect participation in the event? If yes, please explain.

    *I understand that participants must be in good health when arriving at an event. If a participant is found to have a fever, head lice, a virus, or unexplained rash, the parent/guardian will be asked to take them home. Parent/Guardian must stay until riders have been fully checked in at any overnight event.

    *For the 2019-2020 calendar/school year, I do hereby authorize approved adult leaders of Cross of Life Lutheran Church to consent to any medical treatment, dental treatment, or hospital care to be rendered to my child(ren) under the general or specific supervision and on the advice of any licensed physician, dentist, or surgeon. It is my understanding that if the nature of the emergency allows for the time or opportunity, attempts will be made to contact me at the phone numbers provided before any treatment by physician, surgeon, dentist, oral surgeon, or hospital. I understand that in the event my child(ren) is injured or becomes ill and it is necessary for them to receive medical or dental treatment, that my health, dental, and accident insurance will be used to cover such expenses and that I will be responsible for any such expenses not covered by my insurance.

    If you have not already done so, please complete a Media Release Form to indicate your wishes regarding the use of images, video recordings, and audio recordings of you and your child(ren) at church activities in our paper, digital, and online communications. There are paper forms available or an online form can be filled out (https://crossoflifelutheran.org/media-release-form).