SHINE (2nd-5th Grade Ministry)

Welcome to SHiNE!
SHiNE Schedule

5:15 Activities
5:50 Dinner
6:30-7:30 Class

Child's Name

Child's Birthday

Child's Grade

Child's School

Allergies

Any special needs / medical or social concerns you would like us to know?

Parent/Gardian Information

Parent/Guardian 1

Parent/Guardian 2

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 2 Email

This address will receive a confirmation email

Parent/Guardian 1 Phone

Parent/Guardian 2 Phone

Home Address

Name of Emergency Contact (other than parent/guardian)

Telephone Number of Emergency Contact

Relationship to student

Please let us know which activities your child will regularly participate in

Just Class Class & Dinner Class, Dinner, & Activities

MEALS

Dinner will be provided at 5:50. If your child(ren) will eat dinner here, we ask for a yearly fee to help cover the cost. (You can pay ONCE here if you have have kids in SHiNE and RiSE or FLY.) Max fee is $130 per family.

Checks should be made out to GSLC with "Wed night" in the memo and sent to Amy Stewart 327 Woods Mill Rd Manchester, MO 63011.

If you are unable to pay for the whole year now, or if you need assistance covering this fee, please note that we have scholarships available.

Payment

PARENT HELP REQUIRED

The only way we can offer our amazing Wednesday night programming is with a full team of parents each night.

Unless you’ve been assigned as a regular leader/mentor, each family is required to sign up to help 3 nights per semester. If it is absolutely impossible for you to participate, please speak to Emily about how you will help outside of Wednesday nights.

You will be required to sign up by the start of Wed night Youth Club for your 6 nights. More info will be coming soon on how to sign up.

Do you understand the requirement of parents to help 3 times per semester and commit to doing so?

Yes No

CHILDREN & YOUTH VOLUNTEER POLICY AND BACKGROUND CHECK

Having a safe ministry environment for our children and youth is essential at Good Shepherd. When parents entrust us with their children for ministry programs, we take this responsibility very seriously. Therefore, every adult who volunteers with any of our children or youth ministries is required to read our policy and sign that they have read it and agree to abide by the policy for the safety of our children and youth.

Read the GSLC Child & Youth Abuse Prevention Policy

I have read the Child & Youth Prevention Program and agree to abide by this policy.

Yes

Good Shepherd Lutheran Church conducts national criminal background screenings on all employees and all volunteers who work with youth. Good Shepherd is committed to recruiting individuals who do not represent any kind of threat to the well-being of those we serve.

If for any reason a national criminal background screen contains information that may pose a threat to the welfare of anyone, especially our youth, Good Shepherd Lutheran Church will terminate the individual’s work involvement at the church.

I authorize Good Shepherd Lutheran Church to request a national criminal background check based on the following information:

By writing the full legal name of one or both guardians (whomever will volunteer), I am confirming that I agree to Good Shepherd Lutheran Church conducting a national background check on me.

Upon completion of this form, you will receive an email from Ministry Safe within 1-2 days. Ministry Safe is the service we use to conduct background checks. Be sure to check your spam folder. **Your background check will not be complete until you follow the steps from Ministry Safe**

Thank you for keeping our children safe and creating an environment of love and care for all.

PHOTO RELEASE FORM

I understand images of my child may be used throughout Good Shepherd, including, but not limited to: the website, internal postings, the directory, the newsletter and other related putlications. By participating in this program, I grant the irrevocable right to use such photos in all forms and media and in all manners, for said purposes. I hereby forever waive any right to inspect or approve the finished product, including but not limited to, written copy and/or an image in print or on a website that may be created in connecdtion therewith. I understand that Good shepherd cannot control the unauthorized use by personos other than Good Shepherd of said image once such image is putlished. Any claim I may have concerning unauthorized publication of said image must be pursued by me against the unauthorized user. Good Shepherd disclaims any responsibilty for such unauthorized use of the published image.

I have read the Photo Release Form and Agree.

Yes No

PARENT PERMISSION & WAIVER

I give permission for my child, to participate in SHiNE at Good Shepherd Lutheran Church.

Yes No

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

SHINE (2nd-5th Grade Ministry)

The only way we can offer our amazing Wednesday night programming is with a full team of parents each night.

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