VACATION BIBLE SCHOOL REGISTRATION 2019
Vacation Bible School will take place at Joy Lutheran Church in Prescott, WI June 24-28. This event is offered in partnership with Luther Park Bible Camp. Luther Park Counselors will essentially bring the camp program to us. All children from the community are invited to participate in this great event!
The Luther Park Staff will be leading the program along with some volunteers from Prescott. The children will be involved in crafts, games, singing, recreational activities, Bible study, and MORE!

June 24-28, 2019
Monday - Friday 12 noon -5pm for children going into 1st-6th grade,
Monday-Friday 12noon -3pm for children going into Kindergarten.
All children are asked to bring a sack lunch.

Register Today
Space is limited to 60 participants and you must pre register before May 15th, 2019
Transportation deadline is May 1, 2019
Childs FULL Name *
Your answer
Gender
Birth Date *
MM/DD/YY
Your answer
Child's Grade *
Please select the grade your child will be going into 2019-2020 School Year
Telephone number to reach you durring Vacation Bible School *
Your answer
Home Address *
Your answer
Email *
Your answer
Parent/Guardian - In an emergency, notify: *
Name
Your answer
*
Phone Number
Your answer
*
Relationship to Child
Your answer
*
Location while at VBS Day Camp
Your answer
Additional Emergency Contact Person
Name
Your answer
Phone Number
Your answer
Relationship to child
Your answer
Who will be picking your child up? *
Name
Your answer
*
Phone Number
Your answer
Any Food allergies, medical conditions or special circumstances we should be aware of? *
Your answer
Explain any activity restrictions:
Your answer
Do you carry family medical insurance *
If so, indicate:
Carrier
Your answer
Insurance info
Policy or Group #
Trasportation *
Please choose one
My Child is in Prescott Youth sports Camp the Week of VBS
Please choose one
VBS Day Camp Support *
please consider helping cover a portion of the cost
Parent Volunteer
Please consider helping
I understand and certify that my child's participation in Luther Park Bible Camp's (LPBC) VBS Day Camp Program held at Joy Lutheran Church (June 24-28, 2019) and its activites is completely voluntary. I recognize that certain hazards and dangers are inherent in Day Camp events and programs and I acknowledge that although LPBC and the church have taken safety measures to minimize the risk of injury, LPBC and the church cannot insure nor guarantee that the participants’, equipment, premises and/or activities will be free of hazards, accidents, and/or injuries. I further recognize and have instructed my child in the importance of knowing and abiding by LPBC and the church’s rules, regulations and procedures for the safety of participants. I waive any claim against LPBC and the church and/or its person- nel for any lost articles; for any injury to my minor child; and/or any injury to myself. The church assumes secondary insurance coverage. I assume primary coverage *
This health history is correct so far as I know, and the person named on this form has permission to engage in all camp activities except as noted
Required
AUTHORIZATION FOR TREATMENT *
In case of emergency, I understand that every effort will be made to contact the parent(s) or guardian(s) of the VBS Day Camper. In the event I cannot be reached, I hereby give permission to the medical personnel selected by the church to order x - rays, routine tests, treatment, and necessary transportation for my child. I give permission to the physician selected by the church to secure and administer treatment, including hospitalization, for my child as named on this form.
Required
AUTHORIZATION FOR TRANSPORTATION: I hereby give permission for my child to be transported for off site outings. *
Required
AUTHORIZATION FOR USING LIKENESS: I hereby give permission for photographs/ video including my child and/or myself to be used in the promotion of LPBC and/or Joy Lutheran Church. *
Required
COMPLIANCE WITH ELECTRONICS POLICY: I understand that LPBC does not allow any electronic devices except cameras and I certify that I have ensured my child’s compliance with this policy *
Required
ELECTRONIC Signature *
Signature of Child's Parent/Guardian
Your answer
ELECTRONIC Date Stamp *
MM/DD/YY
Your answer
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