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
Your answer
Date of Birth *
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
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.
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