Vacation Bible School Registration
Please fill out the following to register for Community VBS this summer, a ministry of Amery Congregational, East Immanuel, and First Lutheran Churches, hosted at First Lutheran Church in Amery, WI and lead by the talented staff from Luther Point Bible Camp in Grantsburg, WI.

The summer theme is "This Changes Everything" based on Ephesians 2:8--"For by grace you have been saved through faith, and this is not your own doing; it is the gift of God". Every day the kids will experience worship, Bible Study, games, crafts, snacks, and supper. We welcome Pre-K through 5th grade to attend, and also encourage middle and high school youth to be helpers (they should also register here).

This form must be filled out for each individual student you have attending VBS. If you have problems viewing or filling out this online registration form, please return to flcamery.org/VBS to download a registration form to drop off at or mail to the church. If neither of these options work, please email Liz (contact info below) and she will mail a form to you.

The given information is required for Luther Point's Health, Emergency, and Authorization Information, and also for church records. All information given is confidential and secure between the aforementioned churches and their staff, as well as Luther Point Bible Camp staff. If you have any questions or concerns, please let Liz, FLC Youth Director, know: lizbowman001@gmail.com or 715-554-0891. You can also contact Pr. Kathy (East Immanuel) at pastor@eastimmanuel-lutheran.org or Charlotte Gillen (Congo) at youth.ameryucc@gmail.com.

This year's VBS is held from June 17-21 from 5:00-7:30 in the evening. Each night supper will be provided right at 5:00. VBS is free to attend, but a free-will offering is humbly and graciously accepted (suggested donation is $40/child).

Email address *
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's Preferred First Name *
Your answer
Home Church *
Grade Entering *
Male/Female *
Student T-shirt size *
Student Birth Date *
MM
/
DD
/
YYYY
Home Address *
Street, City, State, Zip
Your answer
Parent/Guardian Name/s and Relationship to Student. *
e.g. Jane Doe, Mother.
Your answer
Telephone Contact *
List the most useful numbers to get a hold of the parent/s (cell, home, work)
Your answer
Parent/Guardian location while student is at VBS *
Your answer
Does the student have any physical condition requiring special care? Please explain. *
Your answer
Does the student have any allergies, i.e. food, meds, etc? If so, describe reaction and treatment. *
Your answer
Explain any activity restrictions. *
Your answer
Do you carry family medical/hospital insurance? If so, please indicate Carrier. *
Your answer
Days Student Plans to Attend VBS *
Please note, we want him or her here everyday if possible!
Required
Please read the following waiver. In addition to agreeing here, you will be asked to sign it upon dropping your student off at VBS. *
I understand and certify that my child's participation in Luther Point Bible Camp's (LPBC) Day Camp program held at the church and its activities 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 personnel 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. AUTHORIZATION FOR TREATMENT: In case of emergency, I understand that every effort will be made to contact the parent(s) or guardians(s) of the 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. AUTHORIZATION FOR TRANSPORTATION: I hereby give permission for my child to be transported for off-site outings. 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 the ELCA. 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.
Who will be picking up the student? *
Your answer
My student will need a ride to or from VBS. *
Please note that we cannot guarantee a ride to or from VBS, but we will do our best so that every student is able to attend.
Required
Did we forget to ask you anything? Let us know here.
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