Affirmation of Baptism Registration

2007/08 Affirmation of Baptism Registration

Student Name: Age & Grade: Birth Date: Birthplace: Baptismal Date: Baptism Place: Baptism Sponsors:

Member of McFarland Lutheran Church? Had First Communion? Date: Church Denomination (if Non-Lutheran): Parents Members of McFarland Lutheran Church?

Student's Email Address (if applicable): Student's Cell Phone # (if applicable):

Father's Name: Father's Address: Father's Phone #'s (home, work, cell): Father's Email:

Mother's Name: Mother's Address: Mother's Phone #'s (home, work, cell): Mother's Email:

Student Resides with: Mother: Father: Both: Guardian: Relationship to Guardian:

Emergency Contact (someone we can contact in the event that we are unable to reach you): Name: Relationship to student: Evening Phone #: Cell Phone #:

List any medical concerns that we need to be aware of: Photographing and/or Videotaping Non-Consent Form

Throughout the year Affirmation of Baptism students may occasionally be videotaped and/or photographed in the classroom, during activities or at camp.

The resulting photo and/or videotape may be used in a variety of ways: to promote the congregation and/or specific programs within the community, to instruct students or staff members, or to orient new families, staff and students. The final product could also take a variety of forms: photo displays, slide presentations, newspaper articles, pamphlets or video programs.

Pursuant to the Family Educational Right and Privacy Act, any parent or guardian may inform McFarland Lutheran of their desire that their child NOT be photographed or videotaped by completing the Photograph and/or Videotape Disclaimer below by October 20, 2006.

Photograph and/or Videotape Disclaimer (Only fill this out if you do not want your child photographed and/or videotaped. Please print, complete and mail to: McFarland Lutheran Church, 5529 Marsh Rd., McFarland, WI 53558)

I hereby DENY McFarland Lutheran Church permission to photograph and/or videotape:

Student Name:

Parent Name:

Parent Signature: