Apostle Islands 2026 Registration, Participation & Medical Waiver

I, the Parent/Guardian of... (enter youth's name below...)

Name

Date of Birth

Current School Grade (2025-26)

6 7

Hereby give my approval to his/her participation in any and all activities of Fox Point Lutheran Church during the Summer Youth Trip to the Apostle Islands, July 6-10, 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

Do you approve the Approval?

Approve

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

Today's Date

Address

Parent/Guardian#1 First and Last Name

Mobile Phone

This address will receive a confirmation email

Parent/Guardian #2 First and Last Name

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 Youth

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

Additional Student Info

Student T-Shirt Size

Youth M Youth L Adult S Adult M Adult L Adult XL

Age

School Name

Non-Refundable Commitment

I understand that registrations will be accepted on a first come first served basis, with priority given to those eligible youth who have not been on the trip before. I also understand that in submitting the $250 deposit and registration for my child, I am making a good faith commitment to their participation on the trip, and to my payment of the remaining $250 by May 1, 2026.

I understand the statement above.

Yes

This trip isn’t possible without parent chaperones. Are you able to be one?

Yes No Maybe

PAYMENT

To submit a $250 deposit or pay the full trip cost of $500, please select the desired amount below.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Apostle Islands 2026 Registration, Participation & Medical Waiver

Description

Please Fix the Following