Monumental VBS Registration Form
Atonement Lutheran VBS, June 13th-17th, 9:00 am to noon. Please fill out one form per child. Thank you.
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Child's Name:
Child's gender *
Date of birth: (Must have turned 3 before Sept. 10th, 2021) *
School Grade in Fall of 2022: *
T-shirt Size; *
Parent Name(s): *
Street Address: *
City and Zipcode: *
Parent Phone Number: *
Home Email Address: *
Does the child have any allergies or medical conditions? If yes, please explain. *
Emergency Contact Person and Relationship to Child: *
Emergency Contact's Phone Number: *
Name of Home Church:
Media Release: I do hereby consent and agree that Atonement Lutheran Church, its employees, or agents have the right to take photographs, videos, or digital recordings of me (my child) and to use these in any and all media, now or hereafter. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to Atonement Lutheran Church, its employees, agents all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims or interests I may have to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmissions or playback. *
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