Zion Lutheran and Our Savior's Lutheran Youth Release Form 2021-2022
*Please fill out this form for each child under your care attending youth events during the 2021-22 school year*

I understand that signing this form gives my child permission to participate in any/all youth activities through Zion Lutheran Church and/or Our Saviors Lutheran Church from September 1, 2021 to August 31, 2022.

I understand that the youth activities may include overnights and events that take place away from Zion Lutheran Church or Our Saviors Lutheran Church and the Cloquet area; I also understand this includes permission for my child to participate in any online/virtual experiences through the churches.

I understand that if transportation is required, it will be provided by adult supervisory personnel. I understand that adult leaders will be cleared through the church before providing transportation or supervision.

Should it be necessary for my child to have medical treatment while participating in these events, I understand that the adult leader will make every effort to contact me or any other parent/guardian/contact I've listed in Section 2 of this form. In the event I cannot be contacted, I hereby give the adult leader permission to use their judgment in obtaining medical service for my child. I also give permission to the physician selected by the adult leader to render medical treatment deemed necessary and appropriate by the physician.

I agree to not hold Zion Lutheran Church or Our Savior's Lutheran Church, its officers, agents, employees, assigns or anyone acting on its behalf responsible or liable for injury occurring to my child. Furthermore, I accept financial responsibility in regards to any emergency medical services or transportation needed while my child is participating in these events.

If my child has any lost or stolen items during a youth activity or event I will not hold Zion, Our Savior's or affiliated parties accountable and take responsibility for my child and their lost/stolen items.

If you agree to the statements above, please enter your "signature" and other information below signifying the agreement.
Email *
By checking this box and typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application. *
Parent Signature *
Youth Name *
Date *
Please indicate if you are okay with Zion/Our Savior's posting pictures including your child on websites/social media accounts. Please note names will not be included with pictures for the safety of our students. *
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