St. Peter VBS Registration
VBS TAKES PLACE FROM: August 7 - 11, 2017 5:45pm to 8:00pm (ONE FORM PER CHILD PLEASE)
NAME OF CHILD:
Your answer
AGE:
Your answer
GRADE ENTERING IN THE FALL:
Your answer
ADDRESS:
Your answer
APT. NUMBER:
Your answer
CITY:
Your answer
STATE:
Your answer
ZIP:
Your answer
HOME PHONE:
Your answer
CELL PHONE:
Your answer
EMERGENCY CONTACT NAME AND PHONE NUMBER:
Your answer
HOME CHURCH (if applicable)
Your answer
Allergies: List any your child may have
Your answer
Medical Issues or Special Needs: List any of your childs needs
Your answer
Photo Release: I hereby grant St. Peter Ev. Lutheran 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.
(Please put any comments below)
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.
(Please put any comments below)
Your answer
Permission to Attend: I give permission for my child (named above) to attend the Vacation Bible School listed above. I understand that the information I give for this registration will only be used by St. Peter Ev. Lutheran Church, and that all registration information will be removed from the hosting site by December 31 of this year.
(Please put any comments below)
Your answer
By entering your name and date below you agree that you have provided accurate information and agree to all releases (Medical, Photo, and Attend) to St. Peter’s Lutheran Church.
(Parants type in your name and the date)
Your answer
I WOULD LIKE FURTHER CONTACT REGARDING:
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms