Kids' Night Out/Vacation Bible School

Zion Evangelical Lutheran Church
ELCA
Kids' Night Out/Vacation Bible School Registration Form

Please fill out information below on each child from your family participating.
Name

Childs First NameChilds Last Name
MaleFemale
Birthdate

MonthDayYear
Date
Age
Medical Info Food Allergy or Special Needs
Grade
Name

Childs First NameChilds Last Name
MaleFemale
Birthdate

MonthDayYear
Date
Age
Medical Info Food Allergy or Special Needs
Grade
Guardian Name

First NameGuardian Last Name
Guardian Cell Phone
Email
example@example.com
Address

Address

Street Address Line 2

CityState

Zip
Guardian Name

Guardian First NameGuardian Last Name
Email
example@example.com
Address

Address

Street Address Line 2

CityState

Zip
Guardian Cell Phone
Church Affiliation
Church Membership at
Emergency Contact Name
Relationship
Emergency Contact Phone
Emergency Contact Name
Relationship
Emergency Contact Phone
Family Doctors Name
Phone Number
Permission / Release Information Zion I(we), the parent(s) or legal guardian(s) of the above listed child/children give permission for our child/children to attend and participate in activitiesat Lutheran Church and receive medical treatment if necessary. Every effort will be made to contact me in an emergency. However, if I (we) cannot be reached, I (we) give my (our) permission to the staff to secure the services of a licensed medical service to provide necessary care for my child's well-being. I (we) also release and agree to hold harmless Zion Lutheran Church and all its participants from any and all liability. I (we) assume all risk of injury, damage, or expenseas the result of participation in activities.
Parent Guardian Signature

Clear
Date

MonthDayYear
Date
PLEASE NOTE: For insurance and liability purposes we must have a parent's or legal guardian's name and signature indicating their permission.
PARENTAL AUTHORIZATION TO APPEAR IN PHOTOS AND VIDEOS
I give permission for my child/children listed below to appear in photos/videos associated with Vacation Bible School/Kids' Night Out.
Childs Name
Date

MonthDayYear
Date
Childs Name
Date

MonthDayYear
Date
THE FOLLOWING PEOPLE HAVE PERMISSION TO PICK UP MY CHILD/CHILDREN AFTER KIDS' NIGHT OUT/VACATION BIBLE SCHOOL:
Name
Phone
Name
Phone
Name
Phone
Name
Phone
Printed Name of Parent or Legal Guardian
Date

MonthDayYear
Date
Signature of Parent or Legal Guardian

Clear
Should be Empty:

ELCA

PARENTAL AUTHORIZATION TO APPEAR IN PHOTOS AND VIDEOS

THE FOLLOWING PEOPLE HAVE PERMISSION TO PICK UP MY CHILD/CHILDREN AFTER KIDS' NIGHT OUT/VACATION BIBLE SCHOOL: