Summer Lunch

Summer Lunch runs Mon-Fri from 12-1:30 (Lunch served 12:30-1)

Registration for summer lunch helps with allergies and safety, but is not mandatory.

There is no day camp this year.

First Name of Youth

Last Name

Email Address

Phone Number

Home Address

School Grade

Any allergies or concerns?

Do you need a bike buddy getting to or from the church (please include address and phone)?

Emergency Contact and Phone Number

I give permission for my child's picture to be taken during any events at Shepherd of the Valley for use in local newspapers or newsletters (without names).

Is there anyone who should not pick youth up or be on site? Please name and include physical characteristics.

Release of Liability: I accept unto myself all responsibility and liability for any injury, death or other loss or damage that occurs to me and/or to the minor as a result of the minors participation in Shepherd of the Valley events. I will indemnify and hold harmless the ELCA, its agents, affiliates, volunteers, staff, Shepherd of the Valley, and all participating agencies from all claims, judgments, and cost, including attorneys fees incurred in connection with any action that may be brought as a result of the minors participation in SOV's youth activities.

I have carefully read this agreement and release and I fully understand its contents. I sign of my own free will.

COVID-19 Agreement
I will not send my youth to Shepherd of the Valley if they or a member of my household has signs, symptoms, or has been exposed to COVID-19.

Emergency Medical
In case of an emergency, I give Shepherd of the Valley permission to access emergency medical care if I cannot be reached.

I understand that summer lunch is a drop-in program and not childcare. Youth must be able to take care of their basic needs and not be a danger to themselves or others.

Please enter full name of parent or guardian to accept.