Christ Lutheran Vacation Bible School Registration
One form per child, please!

Miraculous Mission VBS is July 8-11, 2019 --- 9:00 - 11:45am

Student First Name *
Your answer
Nickname?
Your answer
Student Last Name *
Your answer
Age *
Your answer
Gender
Grade entering in fall? *
Your answer
What School Will They Be Attending?
Your answer
Home Church (if applicable)
Your answer
Allergies
Your answer
Medical Issues or Special Needs
Your answer
It would be nice if my child is placed in same group as (child's name)
Your answer
Parent Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone Number *
Your answer
Cell Phone Number
Your answer
Other Phone Number
Your answer
Email *
Your answer
Emergency Contact
Your answer
Emergency Phone
Your answer
Alternate Pickup Name
Your answer
Alternate Pickup Phone
Your answer
Other Information?
Your answer
Medical Release *
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
Photo Release *
I grant Christ Lutheran 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.
Required
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 of this year.
Required
Parents e-Signature *
Your answer
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