Christ Lutheran Vacation Bible School Registration
One form per child, please!

VBS is July 17-20, 2017 --- 9:00 - 11:45am

Student First Name
Your answer
Nickname?
Your answer
Student Last Name
Your answer
Age
Your answer
Gender
Grade entering
Your answer
What School Will They Be Attending?
Your answer
Home Church (if applicable)
Your answer
Allergies
Your answer
Medical Issues or Special Needs
Your answer
It would be nice if my child is placed in same group as (child's name)
Your answer
Parent Name
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
Your answer
Other Phone Number
Your answer
Email
Your answer
Emergency Contact
Your answer
Emergency Phone
Your answer
Alternate Pickup Name
Your answer
Alternate Pickup Phone
Your answer
Other Information?
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. Permission to Attend: I give permission for my child (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church, and that all registration information will be removed from the hosting site by December 31 of this year.
Required
Parents e-Signature
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms