Form – Sunday Morning Experience Enrollment | Immanuel Lutheran Church and School

Your Name*

First Last

Phone*

Email*

Current Address*

Street Address Address Line 2 City State ZIP Code

Child's Name*

First Last

Age*

Grade*

Any Allergies*

No
Yes

List the Allergies Here*

List each allergy, seperated by a comma(s).

Minor Liability & Publicity Release*

By checking this checkbox, I am acknowledging that I am signing this form electronically and accept the terms outlined in the Liability Release below.

LIABILITY RELEASE:
In consideration of being allowed to participate in the Events sponsored by Immanuel Lutheran Church & School, Palatine, IL; and in consideration of the benefits derived therefrom, I on my behalf and, if applicable, on behalf of the Minor named hereby release the Northern Illinois District of the Lutheran Church-Missouri Synod, Immanuel Lutheran Church and School and their present and former trustees, officers, directors, boards, shareholders, employees, agents and their heirs, administrators, executors, successors, and assigns release from any and all claims, demands, actions, suits, proceedings, damages, claims and liabilities of any kind, whether known or unknown, which arise from or are connected with my or the Minor’s participation in the event.

I am aware that in addition to typical activities such as Bible study, worship, sight-seeing, using public transportation, and meal functions; that I or the Minor may participate in various other activities that may involve some risks, such as service projects and recreational activities. I have read the informational materials about this Event and the site and understand the risks involved in the planned activities. I recognize that the conditions, equipment or standards in some of the places which I or the Minor will travel may not be of the same quality level or standards as the conditions, equipment or standards to which I am accustomed. I realize further that there are certain health risks as well as other risks to me or the Minor and our property. I enter into participation in this Event with knowledge of those risks and acceptance of responsibility for any harm, injury or damage resulting therefrom. If for any reason I am unable to complete my stay at the Event, I assume full responsibility for expenses incurred for my return home.

In the event of an emergency, I hereby authorize a leader of this activity, as an agent for me or the Minor, to consent to: any x-ray, examination; medical dental or surgical diagnosis; treatments; hospital care advised and supervised by a physician, surgeon or
dentist (as appropriate) licensed to practice under the laws of the state or country where services are rendered, either at a doctor’s office or in a hospital. I expect to be contacted or my family contacted as soon as possible.

I understand that this document constitutes a full and complete waiver and release of any and all possible claims for any act or omission, including claims for negligence regarding injury or property damages, arising out of my or the Minor’s participation in the Event.

I understand that this release applies to, covers, and includes unknown, unforeseen, unanticipated, and unsuspected risks, damages, losses, or liabilities and the consequences thereof, which result from the matters herein before inferred to as well as those not disclosed and known to exist. The provisions of any state, federal, local or territorial law or statue providing in substance that releases shall not extend to claims or damages which are unknown or unsuspected to exist at the time are hereby expressly waived by me.

Furthermore, I do hereby expressly stipulate, and agree to indemnify and hold forever harmless the Northern Illinois District of the Lutheran Church-Missouri Synod, Immanuel Lutheran Church and School, and their agents, servants, successors, assigns, boards, directors, trustees, officers, employees, and other representatives against loss from any and all present or future claims, demands or actions in law or in equity that may hereafter be made or brought by me or the Minor or on our behalf, related to or resulting from any occurrence, act or omission during the Event, or travel to and from the Event.

I also hereby release and waive any and all claims for liability against any of the host churches, host institutions and the employees, agents, officers, directors, shareholders, contractors and assigns of such host church or host institution or the owner of any sites that I or the Minor may be at during the Event.

By acceptance of participation in the Event, the undersigned agrees to the foregoing and also agrees that the Northern Illinois District of the Lutheran Church-Missouri Synod, Immanuel Evangelical Lutheran Church Palatine, Immanuel Lutheran Church and School, and their employees and other representatives, shall not be liable for loss, damage, injury or inconvenience caused by or resulting from the malfunction of transportation, equipment, strikes, acts of war or insurrection, fire, delays, theft or itinerary or schedule changes or cancellations.

PUBLICITY RELEASE:
I understand photos, videos and sound recordings of students and children may be used on the Immanuel website, yearbook, brochures or other such media for the purpose of public relations, promotion of Immanuel events, recruitment, student records, historical records or other activities that serve to publicize Immanuel Lutheran Church & School. I further understand that all photos, videos and sound recordings will be taken in a public venue and will not offend Christian or civil standards, and that no written identification of any individual student/child will accompany photos, videos, or sound recordings other than those used for student and historical records. I authorize Immanuel Lutheran Church & School to take photos, videos, and produce sound recordings of the above named student or child and to use such photos, videos and sound records.

Signature*

Name*

First Last

Date Signed*

Name

This field is for validation purposes and should be left unchanged.

Sunday Morning Experience Enrollment Form

About the
“Sunday Morning Exerience”
Form

Please use this form to enroll your child in the new Sunday Morning Experience!

Please complete the required fields and press “Submit Your Request” at the bottom of the form. You will then receive a message that confirms successful submission of your request.

Sunday Morning Experience Enrollment Form

About the “Sunday Morning Exerience” Form

Please use this form to enroll your child in the new Sunday Morning Experience!

Please complete the required fields and press “Submit Your Request” at the bottom of the form. You will then receive a message that confirms successful submission of your request.

About the
“Sunday Morning Exerience”
Form