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Living Word Christian Church Navigation
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  • Home
  • Salvation
  • Live
  • About
  • Connect
    • Events
    • Sign-Ups
    • LIFE Groups
      • In-Person
      • Virtual
    • Membership
    • Resources
  • Ministries
    • Kids
    • Youth Alive
    • Phase 2
    • Ladies Exercise Class
    • Godly Women
    • Men Of The Word
    • COTL Daycare
    • Affiliate Ministries
  • Media
    • Communique
    • Services
    • Social Media
  • Giving

Youth Information

Youth Name(Required)
MM slash DD slash YYYY
Gender(Required)
This program runs September 1 - August 31. Even if your youth has completed a grade in school, in this program they are still considered to be in that grade through August 31.
Address(Required)

Parent Information

Parent Name(Required)
Parent Name

Primary Contact Information

Complete this section ONLY if you are the primary contact for the youth, but are not the parent (grandparent, guardian, caretaker, etc.). If you are not the official guardian, also complete the Parent Information.
Contact Name
Address

Emergency Contact Information

Name

Custodial Information

Is there any custodial information that we should be aware of?

Church Information

Do you have a home church?

Special Information

Social Accounts Used:

General Permission

I hereby give permission for this youth to participate in events and activities hosted by Living Word Christian Church and receive oversight from the authorized staff in charge, whose care the youth has been entrusted into while attending and participating in these events and activities. (Note that all staff must be a member of Living Word Christian Church and must comply with a background check and any/all restrictions thereof.)

Consumption Permission

I hereby give permission to Living Word Christian Church for this youth to be offered snacks by authorized staff while in attendance.

Photo/Video Permission

I hereby give permission to Living Word Christian Church to record pictures or videos of this youth while in attendance. I give permission to Living Word Christian Church to use these pictures or videos in church publications including, but not limited to, print publications, slideshows, church website, church social networks, etc. knowing that the youth's identity is kept anonymous.

Travel Permission

I hereby give permission to Living Word Christian Church for this youth to ride in a vehicle designated by authorized staff, for the purpose of transportation to and from events and activities hosted by Living Word Christian Church. (Note that all drivers must be at least 21 years of age and produce a valid driver's license and proof of insurance.). This permission does not include personal transportation, only that as part of the activity.

Medical Information & Permission

Please note all applicable allergies, medical conditions, mental conditions, health history, or medication information that would be necessary in an emergency:
MM slash DD slash YYYY
MM slash DD slash YYYY
General health for the past two years:

Release From Liability

I hereby hold harmless Living Word Christian Church, aka Word of Life Ministries, Inc., and any of its employees, staff, members, and/or volunteers of any liability incurred at or as a result of attending events and activities hosted by Living Word Christian Church.
If emergency or required medical care is needed, I hereby give permission to Living Word Christian Church to such medical care as deemed necessary by medical care providers or the authorized staff.
Completed
MM slash DD slash YYYY
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Online Services

Sundays at 8:30am | Wednesdays at 7:00pm

608-787-5922 | office@lwcclax.com | 2015 Ward Ave, La Crosse, WI 54601