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Participant Registration

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Zoar Lutheran Church

Location

314 E. Indiana Avenue

Perrysburg, OH 43551

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Contact Corryn Short:

419-874-4346

youth@zoarlutheran.com

First, Tell Us About Yourself:

Parent Information

A parent or guardian must fill out the information below. This person will be considered the primary emergency contact during VBS. Contact information for at least one additional emergency contact must also be provided. For safety and security reasons, if other trusted adults may be picking up your child at the end of our nightly programming, please list them as an alternate pick up person. No child will be permitted to leave with an adult that is not so listed without prior discussion with the Director of Youth Ministry or VBS Director.

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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I can receive text messages at this number.

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Alternate Pickup 2 Name

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Alternate Pickup 2 Phone

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Future Youth Programing Information

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Home Church Affiliation

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

Please fill out the questions below about the child you are registering for Vacation Bible School.

**Note that this year, all pre-K participants will need to attend with a trusted adult. We feel that this will help ease the transition to VBS for our younger students who have not attended previously and allow for more flexibility in programing**

First Name

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Last Name

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Grade Leaving

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Gender

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Preferred Pronouns

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Date Of Birth

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Shirt Size

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Allergies

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Medical Concerns

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If child is in PreK, name of adult who will be joining them (first and last):

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If child is in PreK, name of possible alternate adult who will be joining them (first and last):

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Comments

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Liability Release

By clicking this checkbox, I hereby grant permission for my child, named above, to participate in Vacation Bible School activities at Zoar Lutheran Church. I understand that my child participates in this activity at his or her own risk, and I hereby waive and release Zoar Lutheran Church in Perrysburg, Ohio, its Youth Ministry Director, and its volunteer adult supervisors and/or drivers from all liability for any injury, personal or otherwise, to my child or caused by my child during the course of his or her participation in this activity, including during transportation to and from the activity location, if applicable. Should any problems arise concerning the behavior of my child that would require that he or she return home prior to the end of the activity, I agree to be held responsible for any related transportation costs.

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By clicking this box, I hereby authorize the emergency medical treatment of my child, the minor named above, by a qualified and licensed medical doctor if it is the opinion of that doctor that the treatment is medically necessary and I cannot be reached after reasonable effort has been made to secure my personal consent. Further, I agree to be held responsible for any medical expenses that may be incurred as a result.

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Media Release: Pictures/videos of my child may be posted to Zoar social media accounts as a participant in Vacation Bible School events. *Note: If you select No, our volunteer staff will do our best to accommodate. We may cover or blur your child's face in group shots. If a mistake is made, please email youth@zoarlutheran.com and we will remove/edit any photographs as soon as possible.

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