Student/'s Name/s:

Parent/Adult Contact, including daytime phone, home address:

Please list any medical issues, medications, or allergies:

Cross Lutheran Church publishes photos, images, to its public Internet Website and Facebook Page, and print reports (church newsletters, etc.) to promote the image of Cross Lutheran Church and communicate with both the congregation and public. We ask permission to include your image, and that of your child, when applicable, in this type of church communication. If names are used, it will only be the child's first name.