2023-2024 Registration FormUse this form to register for Shepherds of Light, Confirmation and Alleluia Singers this year. Contact Pastor Sherri with any questions. Family/Last Name * Parent Information Parent Name First Name Last Name Email * Phone (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent Name First Name Last Name Email Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Kid Information Program * Please check all programs your student will be attending Shepherds of Light (Pre-K to 5th grade) Confirmation Alleluia Singers Child 1 Name First Name Last Name Date of Birth Date of Baptism Grade Choose Grade Pre-K Kindergarten 1 2 3 4 5 6 7 8 Email (if applicable) Program Please check all programs your student will be attending Shepherds of Light Confirmation Alleluia Singers Child 2 Name First Name Last Name Date of Birth Date of Baptism Grade Choose Grade Pre-K Kindergarten 1 2 3 4 5 6 7 8 Email (If applicable) Program Please check all programs your student will be attending. Shepherds of Light Confirmation Alleluia Singers Child 3 Name First Name Last Name Date of Birth Date of Baptism Grade Choose Grade Pre-K Kindergarten 1 2 3 4 5 6 7 8 Email (if applicable) Consent Form Please Read and Sign by Clicking Box Below * I am the parent or legal guardian of the child(ren) listed above, and I am informed of the activities offered by Shepherd of the Hills Lutheran Church located on 500 Blake Road South in Edina, MN, beginning on August 28th, 2022 and ending on May 28th, 2023. As parent or legal guardian of my child(ren), I hereby consent for my child(ren) to attend and participate in all on site activities provided by Shepherd of the Hills. I consent to any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act for my child. This authority also extends to any x-ray examination, anesthetic, dental, or surgical diagnosis or treatment and hospital care by a dentist licensed under the Dental Practice Act for my child. I further agree to pay all charges for the dental, medical, or hospital care or treatment. As parent or legal guardian of my child(ren), I am responsible for the health care decisions of my child(ren) and am authorized to consent to the services to be rendered. I represent that my consent to and agreement to pay for the dental, medical, or hospital care or treatment to be rendered to my child(ren) is legally sufficient and that no consent from any other person is required by law. I am aware that photographs of my child(ren) may be taken and used on the Shepherd of the Hills website, Social Media pages, newsletter, bulletin, and/or other promotional and event sharing publications. Please contact Pastor Sherri Otto if you do NOT want photos taken of your child. Click here as signature. Health Information Preferred Hospital Name of Physician and Phone Number Name of Dentist and Phone Number Health Insurance Provider and Policy Information Allergy Information and Any Other Health Notifications Additional Comments Is there anything we should know that we did not ask? Do you have any additional comments? Thank you for registering. Feel free to contact Pastor Sherri with any questions. We look forward to gathering again!
