Medical Release Form

This is a new form that will need to be updated as changes occur.  Once this form is turned in, it is kept on file and participants sheets are pulled for each event as needed.  Every youth who intends to participate in any event/program, must have one of these forms on file before participating.  Copies of the forms will be sent home each January for any updates needed.  Hopefully this new system will make for less paperwork for everyone involved.

Click here to print a copy of the Medical Release Form. 

Completed forms can be mailed to Leisha Tays at First Lutheran Church or placed in the Youth Box (under the Youth Board in the Commons at First).  

Medical Release Forms

Those who have release forms on file as of 9/25/07:

Adam Larson

Alex Wieber

Allison Lee (need copy of Ins. Card)

Annie Peterson

Brenna Kelly

Christina Super

Crystal Blahut (need copy of Ins. Card)

Dan Cooper

Daniel Husen

Danielle Linder

Derek Ciesynski

Edward O’Brien

Grace Fishbeck

Haley Larson

Jack Rauchwarter (need copy of Ins. Card)

Jackie Craft

Jacqui Wicklund

Jake Hall

James Ehlenz

Jamie Piekarczyk

Jesse Trowbridge

Joshua Blahut

Katie Hauser

Lindsey Miller

Lissa Skogstad

Martin Santangelo

Meagan Fishbeck

Nathan Pettigrew

Nick Super

Rachel Hauser

Rebecca Dodson

Rebecca Schultz

Richard Pauluk

Ryan Dodson

Sam Hauser

Sami Nellermoe (need copy of Ins. Card)

Sami Schultz

Skylar Wiedow

Susie Peterson

Winter Watson

Permission Slip

The Permission Slip is available by clicking on the link below or you can find hard copies in a pocket on the Youth Board in the Commons at First.
One slip is needed for each off-site event at First Lutheran.

Remember, if a youth does not have a permission slip signed by a parent/guardian, they will not be allowed to attend.

Permission Slip

©2003-2007 First Lutheran Church of Columbia Heights
1555 - 40th Avenue N.E.
Columbia Heights, MN 55421

Last Modified: 7/12/07

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