Registration Form
Please complete the following questions so we can best communicate and serve you through Kids Club this 2021-2022 year. A new form needs to be used for each participant in a family unit.

Kids Club is an after school care program provided by Zion Lutheran of Galesville, WI and takes place Wednesdays 2:30 pm-5:00 pm for children currently in Kindergarten through 5th Grade.
Spring Start Date: March 16, 2022.

Your family is invited to a youth led worship service at Zion at 5:30 - 6:30 pm on Wednesdays for Lent. Middle School Youth from French Creek, Living Hope and Zion Lutheran will be leading the services focused on Prayer.

If you would like to volunteer with this program or have any questions, contact Zion's Director of Youth & Family Ministries: Brianna Iverson at (608) 865-0197 or YouthAndFamily.zion@gmail.com
Sign in to Google to save your progress. Learn more
Child's Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
Current Grade (K-5th) *
Current Name of School (or Indicate Homeschooling) *
How Will Your Child Travel to Zion? *
Parent/Guardian Name(s) *
Email *
Address *
Phone number *
This number is a... *
Can you receive texts? *
Are there any Allergies, Dietary Restrictions, Medical Conditions or Medications being taken by your child that Kids Club Leaders should be aware of? For Upper Elementary female children, has your child started menstruations? If yes, is their/her menstrual history normal? If no, has menstruation been discussed? *
In case of an Emergency I hereby give permission to the medical personnel selected by the church staff to order X-rays, perform routine tests, and treat my child, in the event I cannot be reached in an emergency. I hereby give permission to the physician selected by the church staff to hospitalize, secure proper treatment, and order injection and/ or anesthesia and/ or surgery for myself or my child named herein. Write your name and the date to testify as your signature. Note that we will make every effort to contact you first. *
I hereby give permission to Zion Lutheran Church to use my child’s picture for use in publicity. *
How would you like to receive the Family Page Summary each week?
I would be interested in supporting Kids Club by...
My family would be interested in picking up Supper To-Go (a hot healthy meal) following Kids Club at 5pm from Zion's Kitchen to take home or eat in the Fellowship Hall at Zion.
Clear selection
Any Questions?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms