VBS 2020 Registration Form

Vacation Bible School with Mt. Cross 2020

Fill out the form to register your child/children for VBS July 27th - 31st.
CHILD'S INFORMATION
Name *

First Name Middle Name Last Name
Preferred Name *
Birthdate *

Month Day Year
Date
Grade in School *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent/Guardian (1) *
Cell Phone *

Area Code Phone Number
Email *
example@example.com
Parent/Guardian (2) *
Cell Phone *

Area Code Phone Number
Email *
example@example.com
T-SHIRT SIZE

YXS YS YM YL YXL
.

XS S M L XL XXL
IN CASE OF EMERGENCY
Emergency Contact *
Contact Person
Best Phone *

Area Code Phone Number
Medical Insurance Provider *
Physician Information *
Physician's Name
Phone Number *

Area Code Phone Number
Health Concerns (Allerigies, Medications, etc.) *
I, the parent/guardian of the above named minor child/children:
Please Select One: *

When a parent or guardian cannot be contacted, I authorize an agent of St. John's Lutheran Church (Teacher/Staff Member) to make arrangements for my child to receive medical/hospital care, to include necessary transportation, in accordance with their best judgement. I agree to pay all costs incurred as a result of the emergency which are not covered by my insurance. I do not agree with the above statement and leave the following alternative action in the event of an emergency:
Alternative Actions: *
CHILD SAFETY INFORMATION
I authorize the following people to pick up my child:
The following person/people MAY NOT pick up my child:
PUBLICITY STATEMENT

St. John's Lutheran Church takes photographs and records video footage during various church events for both archival and publicity reasons. These photos may be used in publications such as, but not limited to, the Spokesman, Weekly E-Blast, Departmental brochures, announcements, event advertisements and the website.
- Sunday School
- Vacation Bible School
- Come to Bethlehem
- Blessing of the Backpacks
- Sunday Worship, specifically on festival days
- The Crab Feed
- Santa Lucia
- Various other fundraisers and events
While we cannot monitor if a child is photographed or recorded, we can ensure that photos and videos of children are not published without their parent/guardian's permission.
PUBLICITY RELEASE
*

I, the parent/guardian of the above name minor child give St. John's Lutheran Church permission to publish photographs or video footage of the aforementioned minor in any of their various publications and communications. I will not seek compensation from or pursue legal action against St. John's Lutheran Church or its agents with respect to these photographs or video recordings. I, the parent/guardian of the above name minor child, DO NOT give St. Johns' Lutheran Church permission to publish photographs or video footage of the aforementioned minor in any of their various publications and communications.
Agreement & Consent *

I understand that checking this box constitutes a legal signature cofirming that I acknowledge and agree with the above Terms of Acceptance.
PAYMENT
Payment may be made below through Pay Pal, or through a personal check. Please make the check to: St. John's Lutheran Church and fill in VBS 2020 - Child's name in the memo. Thank you!

Scholarships are available! Please email sarah.jessop.street@stjohnslc.org for details.
Electronic Signature *
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VBS 2020 Registration $ 80.00

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Vacation Bible School with Mt. Cross 2020