St. John Lutheran Church
218 W. 2nd Street, PO Box 365, Alma, KS 66401
Grade completed _____________ Age ___________
Phone Number (List primary and alternate)
Emergency Contact Person and Contact Number
List any food allergies or medical concerns
Family Doctor and Contact Number
Siblings attending VBS (names and ages)
People who may pick up the child
VBS leaders have permission to photograph/film the child(ren) designated above for promotional use at St. John Lutheran Church in association with this VBS program.
Electronic Signature: By entering my name below I agree to the information provided in this form.
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