Shepherd of the Hills
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    Shepherd of the Hills Registration Form

    If you have any questions about this form please contact Deacon Brian Henning.

    Consent Form

    I am the parent or legal guardian of the child(ren) listed above, and I am informed of the activities offered by Shepherd of the Hills Lutheran Church located on 500 Blake Road South in Edina, MN, beginning on September 1st, 2019 and ending on August 31st, 2020. As parent or legal guardian of my child(ren), I hereby consent for my child(ren) to attend and participate in all on site activities provided by Shepherd of the Hills.
    I consent to any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act for my child. This authority also extends to any x-ray examination, anesthetic, dental, or surgical diagnosis or treatment and hospital care by a dentist licensed under the Dental Practice Act for my child. I further agree to pay all charges for the dental, medical, or hospital care or treatment.As parent or legal guardian of my child(ren), I am responsible for the health care decisions of my child(ren) and am authorized to consent to the services to be rendered. I represent that my consent to and agreement to pay for the dental, medical, or hospital care or treatment to be rendered to my child(ren) is legally sufficient and that no consent from any other person is required by law.
    I am aware that photographs of my child(ren) may be taken and used on the Shepherd of the Hills website, Social Media pages, newsletter, bulletin, and/or other promotional and event sharing publications.  Please contact Deacon Brian Henning if you do NOT want photos taken of your child.

    Health Care Information

    Volunteer Opportunities

    Additional Comments and Submit

    Thank you for submitting this registration form. Please take a moment to read through the form and ensure your answers are complete and accurate before submitting.
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Shepherd of the Hills Lutheran Church

We are a connected family of faith inspired by God to positively impact our community and our world.
​500 Blake Road S | Edina, MN 55343 | (952) 935-3457
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