Westosha Lakes Church & Christ Lutheran Church Vacation Bible School 2018
Mon. August 6th - Fri. August 10th, 2018 | 8:45A-12P | Free of Cost | Located at Westosha Lakes Church (24823 74th St, Salem, WI)
For more info, visit westoshalakeschurch.com/vbs.

NOTE: One child per registration form, please.

Name *
Your answer
Birthday *
MM
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DD
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YYYY
Last Grade Completed *
Your answer
Child's T-Shirt Size: *
Parent/Guardian *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Phone # *
Your answer
Emergency Contact Name and Phone # *
Your answer
Home Church, if any *
Your answer
Insurance Company *
Your answer
Policy # *
Your answer
ID # *
Your answer
Any Allergies *
Your answer
Medical Release: By checking yes, I (we), the undersigned parent(s) or guardian(s) of the named participant on this registration form, a minor, do hereby authorize adult volunteers of Westosha Lakes Church as agent(s) for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability Westosha Lakes Church of any of its ministries or leaders in the event of an accident in route, during and returning from the above mentioned event. This agreement does not apply to claims for intentional or gross negligence. *
Required
Photography and Video Release: By checking yes, I (we), the undersigned parent(s) or guardian(s) of the named participant on this registration form, a minor, do hereby authorize Westosha Lakes Church the use of any video and photography that includes the participant for their sole use (Westosha Lakes Church) needs including, but not limited to publicity on their website and promotional materials. *
Required
Please type your (parent/guardian) full name here to serve as your electronic signature: *
Your answer
Please list any additional information you'd like us to know:
Your answer
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