Vacation Bible School Registration
University Hills Lutheran Church July 9-13, 2018, 9:30am-12:00pm

4949 E. Eastman Ave, Denver, CO 80222 ● churchsecretary@uhillslutheran.org ● (303) 759-0161

Please submit by July 2nd.

Email address *
Student First Name: *
Your answer
Student Last Name: *
Your answer
Age: *
Grade Entering: *
Gender *
Parent name: *
Your answer
Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip: *
Your answer
Home Phone: *
Your answer
Cell Phone *
Your answer
Emergency Contact: *
Your answer
Emergency Contact Phone: *
Your answer
Alternate Pickup Name
Your answer
Alternate Pickup Phone:
Your answer
Home Church
Your answer
Allergies: *
Your answer
Medical Issues or Special Needs:
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. *
Required
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. *
Required
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. *
Required
Parent Signature: *
Your answer
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