VBS 2018 Registration
Splash Canyon - Discover God's Promise on Life's Wild Ride
Last Name
(One per Child please)
Your answer
First Name
Your answer
Allergies/Medical Limitations
Your answer
Age
Your answer
Check the Box Grade Completed
Parents' Names
Your answer
Home Address
Your answer
City, State, Zip
Your answer
Cell Phone
Your answer
Home Phone
Your answer
Email Address
Your answer
Emergency Contact/Relationship to Child
Your answer
Emergency Contact Best Phone Number
Your answer
Doctor Name and Phone
Your answer
Anything else that would be helpful for us to know?
Your answer
Home Church
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How Did You Hear of our VBS?
Authorized to sign out your children
We will assume that both mom and dad can sign out child(ren) unless otherwise stated
Your answer
Permission to walk or bicycle home
Signature of parent or guardian
I hereby enroll and give permission for my child to participate in the planned activities of Vacation Bible School at Bethel Lutheran Church in Westmont, IL. The above health information is correct and the child(ren) described has permission to engage in all VBS activities except as noted above. If I cannot be reached in an emergency, I hereby give permission to the medical personnel selected by the VBS director to order X-rays, routine tests, treatment, hospitalization and necessary related transportation for my child(ren) until I am available. Photograph release: By signing below, I indicate that I understand that photos/slides/videos of my child may be taken for VBS. I realize that our privacy will be protected in all photographs and publications of the VBS activities. I understand that no personal information other than name and hometown will be released under any circumstance. Electronics: I understand that no electronic devices are allowed at VBS! Cell phones are for emergencies only. Please type your Name as an electronic signature.
Your answer
Date
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