Teen Life Registration

Please fill out this form and click submit.

Teen's Information

Name

*

Gender

*

Please select one option.

Male Female

Birthdate

*

Teen's Contact

Phone

Email

Address

*

Teen's Scholastic Information

Grade

*

Please select one option.

6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

Name of School

*

Allergies

*

Please select one option.

Yes None

Allergies

Are there any concerns or interests unique to your child that you would like to share to assist us in providing the best experience for your child?

Parent/Guardian Information

Primary Parent/Guardian

*

Relationship to Child

*

Parent/Guardian Phone

*

Parent/Guardian Email

*

Emergency Contact (other than parent/guardian)

Emergency Contact Name

*

Emergency Contact Relation

*

Emergency Contact Phone

*

Photo/Video Authorization

I authorize New Life Lutheran to use photos or videos of my child for promotional use via social media, website, or published material.

Photo Release

*

Please select all that apply.

Yes No

I release all liability for injuries while participating in New Life activities.

*

Please select all that apply.

Yes

Description

Please fill out this form and click submit.

Please Fix the Following

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