Trinity Lutheran Church VBS
Event Timing: August 16th-20th
Event Address: 320 SE Fir Villa Rd Dallas, OR 97338.
Contact us at (503)623-2233 or
Name of Child *
Grade of Child *
Parent/Guardian Name *
Mailing Address *
Phone Number *
Email *
Emergency Contact and Phone Number *
Allergies and/or medical conditions *
Does your child have any special needs (behavioral and/or physical) we should know about? *
Who will be picking up your child from VBS? *
I hereby give informed consent for my child to take part in VBS activities under supervision, and agree that the VBS personnel will not be held responsible from accidents arising therefrom. I authorize the VBS staff/volunteers to provide appropriate treatment to my child for injuries and/or illness. I understand that the information on this form may be released to the appropriate medical personnel in case of a medical emergency. Lastly, I verify that the information on this form is complete and accurate to the best of my knowledge. Please sign below. *
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