VBS 2024 - CELEBRATE THE SAVIOR
REGISTRATION AND MEDICAL CONSENT WAIVER
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STUDENT FIRST NAME *
STUDENT LAST NAME *
T-Shirt Size ($10.00) *
GRADE JUST COMPLETED *
STUDENT FIRST NAME
STUDENT LAST NAME
T-Shirt Size  ($10.00)
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GRADE JUST COMPLETED
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STUDENT FIRST NAME
STUDENT LAST NAME
T-Shirt Size  ($10.00)
清除選取的項目
GRADE JUST COMPLETED
清除選取的項目
STUDENT FIRST NAME
STUDENT LAST NAME
T-Shirt Size  ($10.00)
清除選取的項目
GRADE JUST COMPLETED
清除選取的項目
VBS T-Shirt
I am aware there is a fee for a T-shirt and agree to pay $10 per shirt when I drop my child(ren) off for VBS
 *
PARENT/GUARDIAN NAME *
PARENT/GUARDIAN PHONE NUMBER *
PARENT/GUARDIAN EMAIL ADDRESS *
PLEASE LIST ANY FOOD ALLERGY (Only list FOOD Allergies Please) *
PLEASE LIST ANY MEDICAL CONCERNS OR LIMITATIONS OR MEDICATIONS.  (TYPE NONE IF NO CONCERNS OR MEDS)(PLEASE STATE WHICH CHILD THIS CONCERNS) *
MEDICAL INSURANCE COMPANY (If you have questions please contact Sarah Van Dyken, 320-220-4600)
INSURANCE POLICY HOLDER NAME (If you have questions please contact Sarah Van Dyken, 320-220-4600)
INSURANCE POLICY NUMBER If you have questions please contact Sarah Van Dyken, 320-220-4600)
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