DLC Minneapolis Service Day!

Parent/Guardian's Contact Information

Parent/Guardian Name

First

Last

Phone

Address

Address Line 1

City

State

Zip Code

of Emergency to

Email

Secondary Email

Emergency Contact

First

Last

(Other than Parent/Guardian)

Emergency Contact's Phone Number

Are you signed up to be an adult volunteer/chaperone?

Yes
No

Have you completed and turned in your volunteer Background Investigation Consent form?

Yes
No

How many children will be registering?

1
2
3

Do you give permission for your child/children to be photographed for church/group promotional use?

Yes
No

Signature

Clear Signature

By signing, you consent that your child/children have permission to participate in Dilworth Lutheran Church service projects; are allowed to be transported by volunteers and staff of Dilworth Lutheran Church and have permission to engage in trip activities set forth by the staff of Dilworth Lutheran Church and hereby assume all risk of injury, harm, damage or loss of personal goods in connection with me or my child/children's participation in it. I understand and agree that neither Dilworth Lutheran Church nor its officers, directors, employees or representatives may be held liable in any way for any injury, harm, damage, or loss that may occur to me as a result of my participation in this mission trip. ** I authorize Dilworth Lutheran Church through its trustees, officers, directors, employees or representatives to render or obtain such emergency medical care or treatment for me as may be necessary should any injury, harm or accident occur to me while participating in the mission trip.

DLC Minneapolis Service Day!

Parent/Guardian's Contact Information

Bookings

Registration Information

Booking Summary