2018 VBS Registration
Register me for Berea Lutheran Church's Vacation Bible School "Barnyard Roundup".

Please complete one form for each child.

Monday - Friday, July 23-27 from 9:00-11:30 am

Email address *
Parent/Guardian Name *
Your answer
Cell Phone Number *
Enter a phone number where you can be reached
Your answer
Child's Name *
Enter nickname or first name of your child (and last name if different from your own)
Your answer
Address:
Your answer
Gender:
Date of Birth *
MM
/
DD
/
YYYY
Grade Entering in the Fall *
Allergies: (Food, Insects, etc.)
Your answer
Medical Issues or Special Needs:
Your answer
Will your child be able to take part in the Sunday morning service service? *
We would like to have all the children sing and share what they learned at VBS during our Sunday morning service (July 29, 2018 @ 9:00 a.m.). This helps us to assign roles for the Sunday morning service.
Alternative Pickup Name:
Your answer
Alternative Pickup Phone:
Your answer
Name of Home Church
How did you hear about this event?
Your answer
Other comments or requests:
Your answer
Any days that you are planning to miss?
Your answer
Release:
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.

Photo Release: I hereby grant the above named church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms