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2019 VBS Participant Registration
Lift off for an intergalactic adventure and learn about God's plan of salvation! Open to students entering Prek3 (must be potty-trained) through 5th grade. VBS runs July 15th-19th from 9am - 12pm.
Child's Name: *
Your answer
Gender: *
Entering Grade: *
Parents' Names: *
Your answer
Home address: *
Your answer
Home Phone: *
Your answer
Alternate Phone:
Your answer
Email Address: *
Your answer
Emergency Contact Person: *
Your answer
Relationship to Student: *
Your answer
Home Phone: *
Your answer
Alternate Phone:
Your answer
Food Allergies? *
If yes, please explain:
Your answer
Other Medical Concerns? *
If yes, please explain:
Your answer
Family Doctor: *
Your answer
Doctor's Phone: *
Your answer
Church Denomination: *
Your answer
Church Membership at: *
Your answer
People who may pick up your child? *
Your answer
Additional information we need to be aware of?
Your answer
Photography
VBS leaders have permission to photograph/film the minor(s) designated above in any manner or form for any lawful purpose associated with this VBS program.
Signature (Type your name) *
I hereby affirm that my child shall be participating in the above named activity and certify that I am cognizant of the inherent danger associated with participation in the Activity. I understand and agree that neither St. Paul Lutheran Church and School, nor its trustees, representatives, instructors, agents, and/or coaches are liable for any injury or damage which may befall my child while my child is enrolled in or participating in the Activity. I further agree to save and hold harmless St. Paul Lutheran Church and School, its trustees, representatives, instructors, agents, and/or coaches from any claim by me or my family, estate, heirs, or assigns arising out of my child's enrollment and participation in the Activity. I also authorize St. Paul Lutheran Church and School to render or obtain such emergency medical care or treatment as may be necessary should any injury, harm, or accident occur to my child while participating in the Activity. I further state that I am of lawful age and legally competent to sign this affirmation and release; that I understand the terms herein are contractual and not a mere recital; and that I signed this document of my own free act and volition. I further state and acknowledge that I have fully informed myself of the contents of this affirmation and release by reading it before I have signed it.
Your answer
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