Come One, Come All to Jesus VBS
Hosted by Mt. Zion Lutheran Church, Beacon Church, and Union Avenue Christian Church Will be held at Mt. Zion Lutheran Church - 824 N Monroe St, Litchfield, IL 62056
Child's Name
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First Name
Last Name
Child's Birthday
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Month
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Day
Year
Date
Child's Age
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Parent/Guardian Name - 1
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First Name
Last Name
Parent/Guardian Name - 2
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First Name
Last Name
Primary Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Emergency Contact Information
Emergency Contact - 1
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First Name
Last Name
Relation to Child
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Emergency Contact 1 - Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact - 2
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First Name
Last Name
Relation to Child
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Emergency Contact 2 - Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Primary Care Physician
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First Name
Last Name
Primary Care Physician Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Allergies or Dietary Restrictions - If None, type N/A
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Consent & Liability Waiver
I grant permission for my child to participate in the 2026 "Come One, Come All to Jesus VBS" at Mt. Zion Lutheran Church on Sunday, June 28, 2026.
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Date
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Month
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Day
Year
Date
I will not hold Mt. Zion Lutheran Church, its employees, volunteers, or anyone acting on its behalf, responsible or liable for injury occurring to the named person in the course of such activities.
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Date
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Month
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Day
Year
Date
Please Choose one for Sunscreen Application
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As the parent or legal guardian of the above named child, I hereby give my permission to Mt. Zion Lutheran Church, it's employees and volunteers to apply a sunscreen product of SPF 15 or higher to my child, as specified below, when he or she will be engaging in outdoor activities between the times of 1:00 PM and 6:00 PM. I understand that sunscreen may be applied to exposed skin, including but not limited to the face, tops of ears, nose, bare shoulders, arms, and legs.
As the parent or legal guardian of the above named child, I hereby DO NOT give my permission to Mt. Zion Lutheran Church, it's employees and volunteers to apply a sunscreen product to my child.
Photo & Video Release for Minors (under 18)
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Mt. Zion Lutheran Church has my permission to use my child’s photographs and video footage publicly promote the church and/or VBS. I understand that the images and video clips may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of use.
Mt. Zion Lutheran Church DOES NOT have my permission to use my child’s photographs and video footage publicly to promote the church and/or VBS.
Submit
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