Student Information Form Child's Name *Birthdate *Date of BaptismIf knownGender *MaleFemaleOtherParent 1 NameParent 2 NameHome Phone *Cell Phone *Primary Contact Email Address *Best Email Address to Use for Zoom Sunday School ClassesEmergency ContactRelationship to the Student *Emergency Contact Home Phone *Emergency Contact Cell Phone *Allergies or Health NeedsOther helpful information including learning/behavior issues:St. Andrew’s Picture and Video Release FormYes!By checking this box I I hereby grant the following rights and permissions to St. Andrew’s Lutheran Church. They have the absolute right and permission to take, use, reuse, publish and republish photographic portraits, pictures of video of me or my minor in whole or in part, or composite, without restriction as to changes or alterations from time to time, in conjunction with me or my minor’s own name, or reproductions of such photographs in color or otherwise and in any and all media now or hereafter known, including the internet, advertising or any other purpose whatsoever. I also consent to the use of any published matter in conjunction with such photographs; I waive any right that I or my minor may have to inspect or approve any finished product or products or the advertising copy or printed matter that may be used in connection, with such photographs or the use to which it may be applied. I release, discharge, and agree to hold harmless and defend St. Andrew’s Lutheran Church from any liability by virtue of any reason in connection with the making and use of such photographs or videos that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication of them, including without limitation any claims for libel or violation of any right of publicity or privacy. I hereby warrant that I am a legal and competent adult and/or a parent or legally appointed guardian of the minor, and that I have every right to contract for myself and/or the minor in the above regard. I state further that I have read the above authorization, release and agreement prior to its execution and that I am fully familiar with the contents of it. This release shall be binding upon myself, my minor(s), and our respective heirs, legal representative and assigns. Father, Mother or Legal GuardianDateSubmit Your Student Information FormPlease do not fill in this field.
