2017 Zion Lutheran Vacation Bible School Registration Form
August 6th - 10th, 2017 (6pm - 8:30pm)
221 N Main Street, Tioga ND, 58852
(701) 664-2187
Student Name *
Your answer
Age *
Your answer
Birthdate *
Your answer
Grade entering in the Fall *
Your answer
Allergies or other medical conditions
Your answer
In case of emergency, contact: (Name/Phone/ Relationship to child) *
Your answer
Name of parent(s)/guardian(s) *
Your answer
Parent(s)/guardian(s) Mailing Address; Phone number; Cell Phone *
Your answer
Others who are authorized to pick up your child
Your answer
Medical Release: I give my permission for the VBS staff to administer basic first aid to my child, named above, in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me. *
Required
Photo Release: Parents be aware your child may be photographed during the week of VBS. Photos will be used for church and community promotional purposes only.
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