St. Andrew's Episcopal Church - VBS Participant Registration
Monday, June 24 - Thursday, June 27
9:00 a.m. - 12:00 p.m. at St. Andrew's
1009 W. Princess Anne Road Norfolk, 23507
Questions? Contact Harper Bathel at hbathel@standrewsnorfolk.org

Directions: This form will allow you to share your information and register between 1 to 3 children. Please fill out the entire form and press submit after you finish. Thank you, we are thrilled your family is joining us!

Email address *
Who is my Neighbor 2019 - Learning to love like Jesus
Parent or Guardian Name *
Your answer
Address
Your answer
City
Your answer
Zip Code
Your answer
Cell Phone *
Your answer
Additional Phone Number
Your answer
Name of Emergency Contact in case parent cannot be reached *
Your answer
Emergency Contact Phone Number *
Your answer
Medical Insurance Company Name *
Your answer
Medical Insurance policy number *
Your answer
As the parent or legal guardian, I understand that every effort will be made to contact me before authorization of emergency treatment is given. In the event that I cannot be reached, or if immediate attention is required, I hereby authorize the St. Andrew’s adult leaders to appoint a licensed medical professional to provide treatment on my dependent child’s behalf and I agree to assume responsibility for all medical expenses. *
Required
I grant permission for my child to appear in photos or videos recorded by St. Andrew's Episcopal Church during Vacation Bible School and for these photos to be used on their website and the church's social media pages. *
Required
How did you learn about our VBS?
Your answer
Home Church?
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Child's Name *
Your answer
Child's Age *
Your answer
Child's Last Grade Completed (Summer 2019) *
Your answer
Does your child have any allergies or medical concerns? *
Your answer
Child's Name
Your answer
Child's Age
Your answer
Child's Last Grade Completed (Summer 2019)
Your answer
Does your child have any allergies or medical concerns? *
Your answer
Child's Name
Your answer
Child's Age
Your answer
Child's Last Grade Completed (Summer 2019)
Your answer
Does your child have any allergies or medical concerns?
Your answer
Enter your name here to sign this form (required)* *
Your answer
Today's Date (required) * *
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Please name all persons authorized to pick-up this student from VBS each day (Student will not be allowed to leave with anyone not on this list.): * *
Your answer
Anything else you would like us to know? *
Your answer
Submit
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