109 York Street, Gettysburg, PA 17325

Youth Group Registration Form

Youth Group Registration Form [2023 – 2024]

We welcome your youth’s participation in the youth ministry program at St. James!┬áPlease complete the following information. If you have any questions, please contact the office at 717-334-2012, or Youth Minister, Adam Michael ([email protected]).

Youth Contact Information

Parent/Guardian Information


If your child will come directly to Youth Group after school, please complete a Permission Slip instructing the school to allow St. James Lutheran Church volunteers to pick-up your child or to allow them to ride the bus to St. James Lutheran Church in Gettysburg.

Health & Wellness

In the event that my child becomes ill or is injured, I authorize the adults in charge to take the following steps:

1) Call the parents/guardians. If unavailable, the person below should be called to act on my/our behalf.

2) If the provided emergency contact cannot be reached, I authorize the adult volunteers to use their discretion in securing medical attention and treatment for my child.

I give my permission to the church staff or adult volunteers to seek/administer First Aid in case of a minor medical situation. In the event of an emergency where medical treatment is required, I give my permission to the church staff or adult volunteer to obtain the services of a licensed physician. Please notify me immediately concerning any such emergency. I understand that I am responsible for all costs incurred for such treatment.

Photo Release/Media Permission

St. James uses a number of tools to publicize activities to the congregation and community.
Please read the media release statement and check one of the options below:

I, parent/guardian, give St. James Lutheran Church the absolute right and permission to use the likeness or image of my child in photography or videography that may result in publicity efforts seen by the public. I understand that photography or videography may be used in publications, media release, electronic media or other forms of promotion. I release St. James Lutheran Church, its offices, employees, council, pastors, photographers and designees from liability for any violation of personal or proprietary right I may have in connection with use.

I give my permission for my child(ren), to participate in Youth Group events, choir, and Christian Education activities at St. James Lutheran Church.

You will be asked to sign a printed summary of this registration form and agreement at your child’s first Youth event, verifying/formally authorizing the submitted information on file with the Youth Minister and Church Office.

If you have any questions or concerns, you are welcome to speak with a member of the church staff by calling 717-334-2012.

Please complete this form for each child in your household that will participate in youth activities and events.