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Redeemer Lutheran Church

7755 Greenstone Trail

Fort Collins, Colorado 80525


July 20, 2026


Parent or Guardian's Email Address
Email*
Confirm Email*
First Participant's Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant's

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Third Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Fourth Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Fifth Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Sixth Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Seventh Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Eighth Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Ninth Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Tenth Participant's Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Insurance
Insurance Carrier*
Insurance Policy Number*
Please include a copy of your insurance card below.
Picture of your insurance card. *
  
Valid file types: JPG, GIF, PNG, and PDF
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Select Gender
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's

Activity: NextGen Students Overnight Activities

Functions and Activities

I/We herby, give permission for myself/our student listed above to participate in the overnight activity with Redeemer South Fort Collins or Greeley site. I/We acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity-related accidents, physical injury due to transportation-related accidents, illness, or even death.
I / We hereby give our permission for the representatives of Redeemer to administer necessary First Aid and Medical aid to myself/our student when seen appropriate. I / We realize that every effort will be made to contact the emergency contact on this form for treatment. If the leaders of Redeemer Lutheran Church cannot reach emergency contact, I / We give them permission to admit myself/our student into the care facility at that location. I / We release the agents of Redeemer Lutheran Church from any claim that myself/our student may have or that I / We may have against them as a result of injury or illness incurred during the course of participation in the activities.
I / We hereby give permission for myself/our child to ride in any vehicle designated by the adult in whose care myself/the minor has been entrusted while attending and participating in activities sponsored by Redeemer Lutheran Church.
I give Redeemer Lutheran Church permission to publish any pictures taken of myself/my student in any location by Redeemer Lutheran Church.

Medical Surgeries or Injuries: Are there any past medical surgeries or major injuries that we should be aware of?

Current Medications: Are there any current medications that the participant is using with specific instructions?

Any allergies: Are there any allergies we should be aware of?
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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