Children's Ministry Registration 
Vacation Bible School July 31 - August 4, 2023 5:00-7:30 PM (Dinner Included)
Lorain Lighthouse United Methodist Church 3015 Meister Rd. Lorain, OH 44053
Please complete the entirety of this form, it is good for one year. Each child needs a separate form. 
Contact Information (440) 282-2383 or
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Name of Child *
Grade ('23-'24 school year) *
Email *
Caretaker/Guardians Name 
Address *
Phone Number *
DOB and Age *
In Case of Emergency  *
Who has permission to pick up your child? Please list names, relationship, and phone numbers.  *
Child's allergies  *
Any accommodations needed for child? (i.e. special needs)
(Child's Name) HAS my permission to participate in the following activities* sponsored by LLUMC

*This form will be used for various church activities throughout the calendar year. 
Check all that apply *
Dietary restrictions *
This consent form gives permission to seek whatever medical attention is deemed necessary and releases the church and its staff of any liability against personal losses of named child. 

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/We hereby release the church, its pastor, employees, agents, and volunteer workers from any and all liability for any injury, loss or damage to person or property that may occur during the course of my/our child's involvement. In the event that he/she is injured and requires the attention of doctors, I/We consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a doctor and/or hospital personnel by the church, I/We agree to hold such a person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical treatment should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/We affirm that the health insurance provided above is accurate at this date and will, to the best of my/our knowledge, still in force for the student named above. 

If you agree, consent below. 

Occasionally, Lorain Lighthouse UMC uses photography/videos of children/youth in publicity such as newspapers, newsletters,0 brochures, (etcetera) and on the church website. No last names will be on the internet. Please check one of the options below & underneath.

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