Gloria Dei Lutheran Church Rochester, MN Children's Ministry Registration: Vacation Bible School
Join us as we experience ROAR: Life is Wild; God is Good!

VBS is open to children who will be ENTERING grades Preschool 2 (4 years old by September 1, 2019) through 5th grade in Fall 2019.

Camp dates: June 17-20, 2019
Time: 9:30 - noon (Note: Camp is a half-day program for ALL age groups.)

Cost: $25

Before-care is available from 8 am - 9:30 for an additional cost of $20/child/week

No one will be turned away because of inability to pay.

Signup Deadline: May 15, 2019 or 200 registrations

Contact Krista Monson (kristam@gloria-dei.com or 289-1841) with any questions.

Complete the form for each child you want register. You will receive a confirmation email for each submission.

Email address *
Child's Information
Child's First Name *
Your answer
Child's Last Name *
Your answer
Grade *
Grade going into for FALL -- 2019-2020 School Year
Birth date *
MM
/
DD
/
YYYY
Gender *
I am in need of before-care from 8 - 9:30 am *
Extra cost of $20 per child for the week
I would like to be in a class with my friend
Name of CHILD IN THE SAME GRADE -- we will try to accommodate all requests, but sometimes it is not possible
Your answer
T-Shirt Size *
Elementary School
Answer only for children in grades Kindergarten - 5th
Your answer
Known Allergies or Medical Concerns *
Enter details of allergies/concerns that camp would be concerned with on the "Other" line
Permissions
By submitting this form, I understand that any medications brought to camp must be in their original labeled containers and a current note from the doctor indicating dosage and timing is required. *
I give my permission for Gloria Dei staff to consent to any medical care deemed advisable by this approved emergency clinic or hospital *
Enter medical center name
Your answer
By submitting this form, I understand that I give my permission for my child to take part in an off-site activity (example: playground or gym at Washington or St Pius schools.) *
By submitting this form, I give my permission for my child's photo to be used for publicity purposes. *
Family Information
Child Lives With *
Gloria Dei Membership *
Parent/Guardian Name (1) *
First and Last Name
Your answer
Parent/Guardian (1) Street Address *
Your answer
Parent/Guardian (1) City *
Your answer
Parent/Guardian (1) Zip Code *
Your answer
Parent/Guardian (1) Home Phone *
Enter 'None' if no home phone
Your answer
Parent/Guardian (1) Cell Phone *
Enter 'None' if no cell phone
Your answer
Parent/Guardian (1) Email Address
If different than email address given at top of form. FYI: Confirmation email will only go to that initial email address. Subsequent camp emails will go to all email addresses given.
Your answer
Parent/Guardian Name (2)
First and Last Name
Your answer
Parent/Guardian (2) Street Address
If different than Parent/Guardian (1)
Your answer
Parent/Guardian (2) City
If different than Parent/Guardian (1)
Your answer
Parent/Guardian (2) Zip Code
If different than Parent/Guardian (1)
Your answer
Parent/Guardian (2) Home Phone
If different than Parent/Guardian (1)
Your answer
Parent/Guardian (2) Cell Phone
Your answer
Parent/Guardian (2) Email Address
If different than email address given at top of form. FYI: Confirmation email will only go to that initial email address. Subsequent camp emails will go to all email addresses given.
Your answer
Emergency Contact Information
Information for first person to contact DURING VBS
Emergency Contact Name *
First and Last Name
Your answer
Emergency Contact Relationship to Child *
Your answer
Emergency Contact Phone *
Your answer
Volunteers
We need many youth (6th-12th grade in Fall 2019) and adult volunteers to run VBS! Please volunteer on the Gloria Dei website or at the link on the registration confirmation page.
Additional Information/Comments
Your answer
A copy of your responses will be emailed to the address you provided.
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