The St. Peter’s Lutheran Church Youth Program is called A.S.Y.L.U.M. (Answer So Your Life Ultimately Matters). The youth meet with adult sponsors on Wednesdays from 7:00pm to 8:30pm and on Sunday mornings from 9:45am to 10:45am. There are occasionally other special events.

First Name Of Youth

Last Name Of Youth

Grade of Youth

Birthdate of Youth

First Name of Parent or Gaurdian

Last Name of Parent or Gaurdian

My signature below grants my permission for my child to attend ASYLUM Youth Program on Wednesday nights, Sunday mornings and / or special events.

Signature

Parent or Gaurdian's Email

Parent or Gaurdian's Phone Number

Youth's Phone Number *If texting youth event info is wanted

Allergies

PERMISSION FOR MEDICAL TREATMENT
In case of a medical emergency, in the event I cannot be reached, I give PERMISSION FOR TREATMENT of my child as deemed necessary by a physician and / or dentist.

Single Choice

Yes I give Permission

No I do not give Permission

Doctor's Name

Medical or Insurance Number

Preferred Hospital

Photo Release: I give St. Peter’s Lutheran Church permission to use a photo and any electronic media of myself or my child for possible inclusion on the SPLC website, Instagram, Facebook page, publications, or any advertising of the church and church events.
I hereby release any claims whatsoever in connection with such use of information.

Multiple Choice

Yes, I agree to St. Peter's Photo Release

No, I DO NOT agree to St. Peter's Photo Release