First and Last Name of person completing registration form *
Email Address for confirmation of registration *
Child 1 name *
Birthdate *
Age/Grade as of fall 2012 *
Gender *
Registering for: *
Special needs/allergies/health concerns:
Child 2 name
Birthdate
Age/Grade as of fall 2012
Gender
Registering for:
Special needs/allergies/health concerns:
Child 3 name
Birthdate
Age/Grade as of fall 2012
Gender
Registering for:
Special needs/allergies/health concerns:
Would you like one-on-one assistance for your child(ren) from a Special Needs Buddy? *
Emergency phone *
Has any of the following changed since you last filled out a Lord of Life registration, or is this your first Lord of Life registration? * If yes, please complete the appropriate questions below.
Street address
City, state, zip
Home phone
Parent/Guardian 1 name *
Parent/Guardian 1 cell phone *
Parent/Guardian 1 email *
Parent/Guardian 2 name
Parent/Guardian 2 cell phone
Parent/Guardian 2 email
Permission Section Release from liability: Guardians hereby authorize my son/daughter to participate in said activity. Guardians hereby release, forever discharge and agree to hold harmless, Lord of Life Lutheran Church, from the described event, and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating in the described event. The undersigned further hereby agrees to hold harmless and indemnify Lord of Life Lutheran Church, its directors, employees and agents for liability sustained by said acts of said participant, including any expenses incurred. *
Medical release: The undersigned further consents to the administration of first-aid and/or doctor’s care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the necessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemnify Lord of Life Lutheran Church, its directors, employees and agents from any acts of misconduct, and/or failure to act on the part of those chosen to administer medical aid on behalf of the participant. *
Get Involved! This program is run by wonderful volunteers - we encourage each parent to volunteer a minimum of 1 day. Please check below how you would like to help: Creation Team : Work ahead of time to create the "set" for our stage!Crew Leader : Join us for the week and lead a small group. Be responsible for your "crew" as you move them from room to room and assist with each activity. Get to know your kids and be a significant part of their experience!Snack Prep/Servers : Join us for 1 day or several. Prepare and serve snacks to the children.Theater Station Leader : Lead small groups through an activity. Repeat the lesson for each set of groups that rotate through the station.Arts and Crafts Station Leader Bible Story Adventure Time Station Leader Games Station Leader
Registration is not complete without payment. Cost is $37. You will be brought to the e-pay page when you click submit. Please select the correct quantity when placing items in your cart. If you have questions about Sky or volunteering, please contact Kirstin Delp at kirstind@lordoflife.org.
