Primary Phone * Secondary Phone Emergency Contact's Name * Emergency Contact's Phone * Any restrictions from normal activities? * Current Medications or Allergies? * PLEASE READ My child has permission to attend the various field trips and events associated with the Youth Group of East Side Lutheran Church. I do further give my permission to the chaperones to obtain and administer such medical aid as might be required for the immediate care of my child in the event such help of an emergency nature becomes necessary. I also give my permission to include the administration of such medicines or treatment as might be ordered or administered by a duly licensed physician. It is further understood that the church, its officers, pastors, or chaperones will not be held liable for any first-aid rendered, or treatment, drugs, or medicines administered, or surgical procedure performed pursuant to this consent. In addition, East Side Lutheran Church may use any pictures or videos that my child appears in for promotional purposes. Electronic Signature Agreement *
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide East Side Lutheran Church or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and East Side Lutheran Church. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement.
Parents, if needed, would you be able to act as a chaperone and/or drive for Youth Group activities? *