Vacation Bible School Student Registration
Vacation Bible School: Big Jungle Adventure
June 25-29, 2018
5:30-8:00 pm
Contact: tuffenbeck@stjohnschicago.org
Student Name (Last, First): *
Your answer
Nickname:
Your answer
Gender:
Please indicate student's age or if they have completed Kindergarten. *
Please indicate most recent grade student has completed. *
Parent Name (Last, First): *
Your answer
Address (please include city, state, and zip code): *
Your answer
Email: *
Your answer
Phone Number: *
Your answer
Alternate phone number:
Your answer
Home Church (if applicable):
Your answer
Name of Adult picking up: *
Your answer
Alternate pick up:
Your answer
Emergency Contact Name: *
Your answer
Emergency Contact Number: *
Your answer
Student Medical Information (allergies, special needs, other issues):
Your answer
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
General Information:
Your answer
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.
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, and that all registration information will be removed from the hosting site by December 31, 2018. *
Required
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