Student Information

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Parent/Guardian Information

Mailing Information

Insurance Information

Emergency Contact

Liability Release

This Agreement and Release of Liability must be read, agreed to, and signed electronically by both the YOUTH PARTICIPANT(S) and a PARENT or GUARDIAN. You may also print, sign, and bring this form with you to Kindred Lutheran Church.

I (We) acknowledge that participation in any and all Kindred Evangelical Lutheran Church (AKA Kindred Lutheran Church, Kindred Lutheran, KLC) programs or events is voluntary and may involve activities that require traveling or physical exertion. We agree to the following conditions for participation in the ministries of Kindred Evangelical Lutheran Church of Kindred, ND.

Kindred Lutheran Church is not responsible for the loss or theft of personal belongings. Misconduct may result in the transportation home of my child from an activity at the parent/guardians expense. A participant sent home for disciplinary reasons will NOT receive a refund of any fees.

Participation in Kindred Youth Ministry events or programs is a privilege, this privilege may be denied by a Kindred staff when, in their opinion, participation of the youth is disruptive and not keeping with the mission of KLC.

I understand that my child may be photographed and/or filmed and his/her image may be used in video presentations, printed publications, eConnections, or on Kindreds website or facebook page or other electronic media. Your childs name will not be published.

I hereby take the following action for my child, myself, my executors, administrators, heirs, next of kin, successors and assigns: A) I waive, release and discharge from any and all claims or liabilities for death or personal injury damages of any kind, which arise out of or relate to my childs participation in the events and programs of Kindred Lutheran Church, the following person, or entities: Kindred Evangelical Lutheran Church, its pastors, staff, employees, members, volunteers, chaperones, representatives, subcontractors and agents of any of the above; B) I agree to indemnify and hold harmless and not to sue any of the persons or entities mentioned above for any claims or liabilities that I have waived, released or discharged herein including all claims, judgments and costs including attorneys fees; and C) I indemnify and hold harmless the person or entities mentioned above from any claims made or liabilities assessed against them as a result of my childs participation in KLCs related activities. I hereby assume the risk of my child participating in all Kindred Lutheran Church ministry activities or programs.

I agree to indemnify and hold harmless the person or entities mentioned above for any claims or liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the minor in the execution of the release.

I hereby authorize any licensed physician, emergency medical technician, hospital or other medical or health care facility to treat the minor named herein for the purpose of attempting to treat or relieve any injury received by said minor. I authorize any such Medical Provider to perform all procedures deemed medically advisable in attempting to treat or relieve any such injuries. I consent to the administration of anesthesia as deemed advisable. I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and assume any and all such risk for and on behalf of myself and said minor. I understand that attempts will be made to contact me in the most expeditious way possible. Permission is also granted to Kindred Lutheran Church representatives to provide needed emergency treatment to the student prior to his/her admission to a medical facility.

By typing my name below, I agree with the conditions detailed above and hereby grant permission for my child to attend and participate in all programs or events of Kindred Evangelical Lutheran Church. 

Tip: Please type your full name into the box.

Behavior Contract

NEW FOR 2023-2024. PLEASE READ CAREFULLY

As a participant in the Kindred Lutheran Church (KLC) Youth Ministry, you not only represent yourself, you also represent your family, Kindred Lutheran Church, KLC Youth, and the city of Kindred. It is your responsibility to help make confirmation classes, youth group activities, programs, events, and trips positive and enjoyable experiences for yourself, fellow youth, and adults. You are expected to demonstrate high standards of conduct and accept personal responsibility and consequences for your actions. You are expected to exhibit honesty, courtesy, and consideration towards others.  This includes those in our group as well as anyone else with whom you may come in contact.  The goal is to make all our confirmation classes, youth group activities, programs, events, and trips safe and enjoyable experiences for everyone, creating an environment for strong Christian fellowship, learning, and growth in your relationship with Christ. This includes programs at KLC and away.

We expect you, the participant, to obey the following rules of behavior: 

  • The participant is to follow any specific directions/rules/regulations established by the leadership both prior to and during any program, event, or trip.
  • The participant shall not in any way be involved with smoking, vaping, alcohol, illegal drugs, vandalism, theft, bullying, hitting, pushing, fighting or any other type of behavior that is judged by the adults to be detrimental to the health, well-being, safety or reputation of him/herself or anyone else in the group, including adults. 
  • Participants are expected to be encouraging and use encouraging words. No complaining.
  • No inappropriate language will be tolerated.  This includes, but is not limited to, being disrespectful towards youth or adults, taking the Lords name in vain, and degrading or mean-spirited comments.
  • No public displays of affection or inappropriate contact. While on trips, participants may not go in rooms of the opposite gender.
  • Participants will always stay in groups. While at church or on a trip, participants may not be alone with a student of the opposite gender.
  • For certain events/trips, there will be a curfew established for the group. All participants will abide by these times. 

Methods of Discipline: 
If any of the above rules are not followed, the following will occur: 

  1. On the 1st offense, the youth will receive a vocal warning. 
  2. One the 2nd offense, the youth will be pulled aside by a leader to discuss the offense and may include a discussion with parents/guardians. 
  3. On the 3rd and additional offenses, the youth will be asked to call his/her parents/guardians and explain the situation. The parent/guardian and youth leadership will discuss further action. If the infraction is severe enough, the potential exists for permanent exclusion from future youth ministry programs, events, and trips. If the infraction occurs on a trip, this may include the possibility of sending the student home at the expense of the parent/guardian. 
  4. Special Note: Certain infractions can result in an immediate dismal and sending home of student at the expense of the parent/guardian. These infractions include but are not limited to: being involved with any alcoholic beverages, tobacco, vaping, illegal drugs, weapons, theft, or any other illegal activity. 

Parent/Legal Guardian:

I have read and reviewed with my child the KLC Youth Ministry Behavior Contract (Contract) and agree that my child shall abide by all the rules and regulations as outlined above. I agree that if my child fails to abide by the Contract or engages in any infraction of the Contract whatsoever, that my child can be dismissed from the program, event, or trip. If they fail to abide to the Contract while on a church sponsored trip, they may be sent home immediately at my expense for the transportation home with no right of reimbursement for any amount in connection with the transportation or missed aspects of the trip. Additionally, future participation in KLC Youth programs/events/trips may be impacted.

Tip: Please type your full name into the box.

Youth

I have read, understand, and agree with the KLC Youth Ministry Behavior Contract (Contract). I also understand and agree that my parent(s) or guardian will be notified at the time of any infractions requiring my dismissal from the youth event and that I will be sent home at my own or my parent or guardian's expense. Additionally, my participation in future KLC youth ministry/events/trips may be impacted. 

Tip: Please type your full name into the box.