Electronic Registration Form
Rocky Railway VBS: August 8-11, 5:30-8:00PM at Antigo United Methodist Church, 2034 Fifth Ave.
Please fill out a separate form for each student.
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Student Name *
Date of Birth *
Last grade completed *
Name of school *
Parent/Guardian Name: *
Home Phone *
Address *
Emergency Contact 1: Name *
Emergency Contact 1 Phone number *
Emergency Contact 2 Name *
Emergency Contact 2 Phone Number *
Primary email address *
List any health conditions or disabilities and the appropriate action (e.g.asthma, allergies seizures, etc.) *
Please read the following statement and electronically sign this form: I release and hold harmless Calvary Lutheran Church and Antigo United Methodist Church and any of its employees and volunteers from any and all liability or injury incurred by my child while participating in all Vacation Bible School activities. *
I give my permission for my child’s photo to appear on websites or media of the sponsoring churches or in the local newspapers. *
Electronic Signature: Please sign by typing your first and last name. *
Electronic Signature: Date form completed *
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