2019-2020 HTLC Youth Participation Form
In order to register for VBS, you must complete this form in its entirety.

By doing so, you will also have completed the Youth Participation form for the 2019-2020 school year, and your child may participate in other activities at HTLC as indicated below.

One form per child please.

2019 Vacation Bible School Information
June 17-21, 2019
9:00 am - 12:30 pm*
*Please note the new ending time.

The VBS Program is designed for Children age 3 (before 8.31.18) through 6th grade (during the 2019-2020 school year). Older children may sign up as Youth Helpers. Younger children are welcome in the nursery during VBS if their parent is a registered VBS Adult Volunteer.

VBS Registration Deadline: June 3, 2019 - FIRM
Registrations received after the deadline, including walk-ins during VBS week, may not be accepted.

Participant's Tshirt Size *
Friend/Family member the participant wishes to be grouped with (other than his/her own grade level):
The VBS program and activities are designed to be grade-appropriate. Therefore, we prefer that all participants stay with their grade. However, if your child wishes to participate with a different grade, in order to be with a friend or family member, please type the friend/family member's name below (one grade level up or or down only). We will try to accommodate all requests, keeping in mind that class size, supervision, and safety are top priorities.
Your answer
VBS Sign In/Out Procedure: *
I agree and understand that every participant must be signed in and out of VBS each day by a parent, guardian, or other authorized adult. Sign-ins/outs must take place BOTH at the registration table AND with the participant's leader. Participants may not be signed in before 8:50 a.m., and they must be signed out promptly at 12:30 pm.
2019-2020 HLTC Youth Participation Form
This form must be completed annually, by a parent or guardian, for everyone under the age of 18 who will be participating in any activity at Holy Trinity.
Participant's Last Name *
Your answer
Participant's First Name *
Your answer
Name Participant Prefers to Be Called *
Your answer
Participant's Date of Birth *
MM
/
DD
/
YYYY
Participant's Grade in the 2019-2020 School Year *
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Email Address(es) *
Your answer
Home Address *
Your answer
Best Phone *
Your answer
Alternate Phone *
Your answer
Emergency Contact (if different from above)
Your answer
Emergency Contact's Phone #
Your answer
Emergency Contact's Relationship to Participant
Your answer
Activities for Participation (select all that apply) *
Required
Are there any activities in which your participant should not participate? Yes/No? *
If so, please elaborate.
Your answer
Does the participant have any allergies that we need to be aware of? Yes/No? *
If so, please list.
Your answer
Does the participant carry an EpiPen? *
If yes, please bring one to each activity.
Please list anything else you would like us to know about the participant.
Your answer
Person completing this form: *
Your answer
Relationship to participant: *
Your answer
PERMISSION TO PARTICIPATE: I give my permission for my child/grandchild/foster child to participate in all activities of Holy Trinity Lutheran Church, including faith formation, youth, and music programs ("HTLC Activities"). I understand that he/she will be participating in HTLC Activities that are grounded in Christian education, music education, character building, team building, and spiritual growth. *
RELEASE OF LIABILITY: I agree and understand that with each HTLC Activity, there is risk involved. In consideration of this, I specifically release and hold harmless Holy Trinity Lutheran Church, including but not limited to the Pastor(s), Staff and Volunteer leaders from any and all liability claims, illness or property loss that my participant or I may sustain while participating in HTLC Activities. *
PHOTO RELEASE: I give permission to Holy Trinity Lutheran Church to take and use pictures/videos of my participant during HTLC Activities for bulletin boards within the church, in church publications and/or on the church website, in news releases/articles of public media or other forms of church-related social media (Facebook, Instagram, Twitter, Snapchat, etc.) *
HEALTH INFORMATION/CONSENT TO SEEK TREATMENT: I give the staff and volunteers at Holy Trinity Lutheran Church permission to assess any accident, injury, or illness that may occur to my participant while he/she is participating in church-sponsored activities/trips. I also give my permission for the staff and volunteers to seek medical treatment for my participant if their assessments of the situation deem that treatment/medical attention is urgently necessary. I understand that I will be notified of any treatment/medical attention as soon as the situation allows. *
Health Insurance Information: Insurance Carrier *
Your answer
Health Insurance Information: Phone # of Carrier
Your answer
Health Insurance Information: Policy Holder's Name *
Your answer
Health Insurance Information: Policy Holder's Relationship to Participant *
Your answer
Health Insurance Information: Group/Policy #
Your answer
TRANSPORTATION: I give the Staff and/or Volunteers at HTLC permission to transport my participant to off-campus HTLC activities (e.g. Youth events, Retreats, Service Projects, Music events, Faith Stepping Stone Activities, etc.). I understand that: *
There shall be a minimum of two adults present when transporting Children and Youth for church sponsored activities. Adults may be in separate vehicles as long the caravan is traveling together. Use of church-owned vehicles is preferred over the use of personal vehicles. In cases where personal vehicles are used, Adult volunteers who will transport Children/Youth in their personal vehicle or another sanctioned vehicle must meet the following requirements: be 21 years of age or older; possess a valid Driver’s License; Vehicles must have proper safety restraints for all passengers (Children under 8 years of age and/or under 80 pounds must use a car seat or booster seat as appropriate).
TRANSPORTATION: The following people are NOT permitted to transport my Child/Youth to off-campus HTLC activities:
Your answer
PICK UP: For children in 4th grade and under, is /are there any person(s) to whom your child is NOT to be released? Yes/No? If yes, please list: *
Unless otherwise specified, Children in 4th grade and under who are participating in Faith Formation Classes, Music Ministry Programs will remain with a Staff or Volunteer until a parent/guardian, adult family member, known family friend, or sibling 5th grade or older arrives to pick them up.
Your answer
Parent Signature: By entering my name below, I acknowledge that I am signing this HTLC Youth Participation Permission Form electronically. I agree this electronic signature is the legal equivalent of my manual signature on this Form. I also represent that I am authorized to submit this Form for my Participant and that all of the above information is correct. I also confirm that I consent to the above releases. *
Your answer
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