W4C/Confirmation/Luther Lights Registration

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Please fill out a separate form for each student

Student Name *

Gender *

Female

Male

Prefer not to say

Birth Date *

YYYY

Address *

Please include full address with: City, State, Zip

Student Phone Number (if applicable)

Grade child will enter in 2026/2027 School Year *

School (East/West Fairview, homeschool, etc.) *

T-Shirt Size *

Parent/Guardian Name 1 *

Cell phone for Parent/Guardian 1 *

Parent/Guardian Email 1 *

We will be using the Remind App for correspondence, please provide your email!

Parent/Guardian Name 2

Please include 2nd Parent/Guardian

Cell Phone for Parent/Guardian 2

Parent/Guardian Email 2

We will be using the Remind App for correspondence, please provide email if applicable!

Emergency Contact *

Please provide an emergency contact (other than parents)

Relationship to Student *

Emergency Contact Cell Phone *

My Child/Student may be released to: *

Please list all contacts who may be picking student up through the year.

My Child/Student MAY NOT be released to: *

If child/student may not be released to an individual, please list below or put N/A.

Allergies *

Please list or put N/A

Dietary Restrictions *

Children are fed a meal each week, please include any and all dietary restrictions, or put N/A

Child's Congregational Membership *

Please list if other than Zion Lutheran Church or put N/A

Any other information about your child you wish for us to know?

Do you give permission for any pictures taken during ZLC youth programs to be used for promotional purposes? *

Facebook, posters, etc.

Yes

Do you give permission for your child/student to leave Zion Lutheran's property for ZLC Youth Programs? *

Could include: Nature walks, helping clean our community, trips to the park, etc. (Large events will be communicated beforehand)

Yes

Do you give permission to receive mailings about ZLC activities? *

Yes

I understand that every effort will be made to contact me if my child/student needs emergency treatment. I hereby give my permission to secure proper medical treatment if none of the parental/guardian/emergency references can be contacted.This completed form may be photocopied for various church leaders to have access to. We will be utilizing the Remind App for any/all announcements as well as making updates to the Zion Lutheran Church Facebook page and the Zion Lutheran Website: zlcfairview.com *

Acknowledge

Reminders for the 2026-2027 Warriors 4 Christ year:
o Warriors 4 Christ will only be operating for the first three Wednesdays of every month. We will send this reminder out through the Remind App also
o The 4th Wednesday of every month will be reserved for the Luther Light group to meet. This is open to any high school aged child looking to grow in their faith, gain volunteer experience and be an involved community member. Please reach out to the church with any questions.
*

Acknowledge

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