VBS 2019 Registration and Permission Form
This authorization is valid July 22-26, 2019
Redeemer Lutheran Church, 1545 Chain Bridge Rd, McLean, VA 22101
Contact us at 703-356-3346

The cost for VBS this year:
$30 for youth age 3 through grade 3 (fall 2019)
$50 for youth grade 4-6 (fall 2019)

Email address *
Youth Name (Last, First) *
Your answer
Grade Entering Fall 2019 *
Required
Birth Date *
MM
/
DD
/
YYYY
Parent Name(s) (Last, First) *
Your answer
Address *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Best email address(es) to use *
Your answer
Allergies
Your answer
Dietary Restrictions
T-shirt Size *
Emergency Contact (name, relationship, phone) *
Your answer
Permission to participate in youth activities: I hereby grant permission for my child to participate in Redeemer Youth Ministry activities under the supervision of adult chaperones. I understand my child may engage in physical activities with risk of injury. *
Required
Permission for Emergency Medical Treatment: In the event that I cannot give authorization in person, I hereby authorize an adult chaperone from Redeemer Lutheran Church to seek emergency medical treatment for my child. *
Permission for Photography: I give permission for my child's picture to be used by Redeemer Lutheran Church for publicity purposes. *
Permission for adult chaperones to transport youth to and from daily service projects, (for 4-6 grade.)
Willing to volunteer at VBS? *
A copy of your responses will be emailed to the address you provided.
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