Grace Lutheran & Atonement Lutheran Church Bloomington, MN Vacation Bible School Registration for June 17-21, 2019
Please complete all the questions for the Registration and click SUBMIT at the very bottom: (Separate form for each child)
Email address *
What is Child's Name? *
Your answer
What age group for this child?(Grade completed)
Parent(s) Guardian Name(s) *
Your answer
Address *
Your answer
Phone number you can be reached at *
Your answer
Does your child have dietary concerns, allergies or are there other instructions the staff should know? (this is a required question if none - enter none) *
Your answer
No child will be released for pick-up to a person other than legal guardian as indicated above unless indicated here: (I authorize the person(s) listed here to pick -up my child in the event I am delayed or unable to pick up my child. (Name and phone number are listed) *
Your answer
Are you as a parent or guardian able to help in any of the following ways? Check all that apply *
Required
In case of emergency, Vacation Bible School will call 911. Please provide an emergency contact person and their phone number if you cannot be reached. *
Your answer
In case of emergency please provide your child's medical insurance information here. If "none", please indicate "none". Provide group and identification number as well as name of insurance name and phone number *
Your answer
I understand and certify that my child's participation in Grace & Atonement Vacation Bible School 2019 (VBS19) and it's activities is completely voluntary. I recognize that certain emergencies may arise and I acknowledge that although safety measures have been implemented to minimize the risk of injury, that (VBS19) cannot guarantee that the participants, equipment, premises and /or activities will be free of hazards, accidents, and/or injuries. I further recognize and have instructed my child of the importance of knowing and abiding by (VBS19) rules and procedures for the safety of participants. I waive any claims against (VBS19) and/or its personnel for any lost articles, for any injury to my child or myself. (VBS19) assumes secondary coverage. I hereby give permission for my child to be given emergency medical care, to be transported for offsite outing, and for photographs/video including my child and/or myself to be used in the promotion of VBS. By signing below, I acknowledge that I have read, understand and agree to registering my child for Vacation Bible School. (sign your name below) *
Your answer
A copy of your responses will be emailed to the address you provided.
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