Youth Mission Trip - Registration & Waiver 2026

Student T-Shirt Size

Youth L Adult S Adult M Adult L Adult XL

I, the Parent/Guardian of__________. (Enter CHILD'S FIRST NAME BELOW)

Their Name (child's name)

Birthdate

How old are they?

13 14 15 16 17 18 19

Current 2025-26 School Grade

8 9 10 11 12

ROOMING BUDDY
Does your child have a preference of a Rooming Buddy? We can't necessarily guarantee they'll end up together, but it is helpful knowing. Enter their first and last name below, or skip to the next question.

First and Last name of preferred buddy:

Youth Mobile Phone

Youth Email

Address

Approval

Hereby give my approval to his/her participation in any and all activities of Fox Point Lutheran Church during the period of September 1, 2025 through August 31, 2026. I assume all risks and hazards incidental to such participation, including transportation to and from activities. I do hereby waive, release, absolve, and indemnify the church, its servants, and participants, as well as transporting the above named child to and from related activities, for any injury or action resulting in a medical claim. I also give the physician/hospital selected by the program supervisor permission to secure proper treatment for my child, should it become necessary. I also assume responsibility of all medical expenses incurred. Should it be necessary for my child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.

Approval Signature

Do you approve the Approval?

Approve

Parent/Guardian Signature (enter Parent's first and last name)

Today's Date

Guardians & Emergency Contact

Parent/Guardian #1 First Name

Parent/Guardian #1 Last Name

Are you interested in chaperoning?

Yes No Not sure yet

Mobile Phone

This address will receive a confirmation email

Parent/Guardian #2 Name

Are they interested in chaperoning?

Yes No Not sure yet

Mobile Phone #2

Email #2

This address will receive a confirmation email

Emergency Contact Person OTHER THAN PARENT (first and last name)

Emergency Mobile Phone

Relation to Child

Medical Waiver

Insurance

Insurance Company:

Policy Number

Insurance ID Number:

Physician’s Name

Physician’s Phone Number

Known Allergies

Special Dietary Restrictions

Special Medical Conditions/Concerns

Medications - include instructions/dosages

Date of Last Tetanus Shot

FUNDRAISING

As part of preparing for our mission trip to Asheville, NC, students will help host “A Meal for the Journey,” a dinner theater fundraiser on April 24.

This event will help support the trip and is an important part of our preparation as a group. All students participating in the mission trip are expected to help with planning, preparation, and hosting the event.

In the weeks leading up to the fundraiser, we will gather after worship from 12:00-1:00 pm to plan the program, prepare the entertainment, and organize the evening together.

Planning Gatherings:

March 29

April 12
April 19
April 23

Students should plan to attend these gatherings as part of their preparation for the trip.

Fundraising Family Participation

Events like A Meal for the Journey are made possible through the support of our families and church community. If you or another family member would be willing to help with the fundraiser, please indicate below. We will follow up with more details as the event approaches.

Family Participation

Donate ingredients or supplies to help prepare the meal Assist with event setup (tables, decorations, room preparation) Help during the event (kitchen support, serving assistance, or hospitality) elp with cleanup after the event

Payment

TODAY'S DEPOSIT
The $250 Non-refundable Deposit is due at the time of submitting this form.

FINAL PAYMENT
Due by May 1, 2026. (An invoice for the remaining $550 balance will be sent to you via email.)

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Youth Mission Trip - Registration & Waiver 2026

Description

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