Bible Super Hero Vacation Bible School
First Lutheran Church VBS
ONE FORM PER CHILD, PLEASE

Event Timing: June 18th - 21st 2018
Time: 6:00 pm to 8:30 pm
Event Address: 2808 South Avenue | Missoula, MT 59804
Contact us at (406) 549-3311 or flcmissoula@aol.com

Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Nickname
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Age *
Your answer
Gender *
Grade (just finished) *
Your answer
Home Church (if applicable)
Your answer
Known Allergies
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Medical issues or Special Needs
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Place my child in the same group as (child's name)
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Parent Name (First and Last) *
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Mailing (Street Address) *
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City *
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State *
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Zip *
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Email *
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Home Phone Number
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Cell Phone Number *
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Emergency Contact (First & Last Name) *
Your answer
Phone Number for Emergency Contact (First & Last Name) *
Your answer
Alternate Pickup Person (First & Last Name)
Your answer
Phone Number Alternate Pickup Person (First & Last Name)
Your answer
Waiver and Release
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.

Parent Digital Signature & Date
Parent Signature & Date *
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