SAE VBS 2022 Registration Form

Bethlehem Lutheran & St. Andrew's Episcopal Churches Present:

Monumental Vacation Bible School 2022
Ages 4 years old through 6th grade

June 27- June 30th, 2022 9 am - 12 pm
Child Name

First Name Last Name
Age/ Grade in Fall
Gender
Child Name

First Name Last Name
Age/ Grade in Fall
Gender
Child Name

First Name Last Name
Age/ Grade in Fall
Gender
Parent Name

First Name Last Name
Parent Phone Number
Please enter a valid phone number.
Parent Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Church
I would like to volunteer (you will be called/emailed with details)

Yes No
Please list children's allergies/medication/health information in space below
COVID Vaccination Status of each child, list below
Additional Emergency Contacts: List Name and Phone Number
Authorized Pick-Up List
I give my children permission to attend Bethlehem Lutheran Church Vacation Bible School (VBS). I give my permission for my child to be photographed and videotaped for VBS only. Photos used on church web-site will not have names posted.

I will follow all COVID protocol while on Bethlehem’s campus that will be put out prior to event date. I will not send my child to Vacation Bible School if she/he/they have been exposed to COVID-19 in the past 10 days.

In the event of a medical emergency and if none of the emergency contacts identified below can be reached, Bethlehem's VBS staff will call 911. As the parent or authorized representative, I give consent to Bethlehem Lutheran Church to obtain all emergency medical or dental care prescribed by a duly licensed physician or dentist for the child(ren) named above. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of the child(ren) listed above.
I consent to the above

Yes No
Please Note VBS is for children ages 4 years old through sixth grade - Once your child is entering 7th grade, they can volunteer to be assistant crew leaders or activity station helpers.

Cost: Tuition is $75 per child with each additional child $30. Scholarships available contact Constance Mithelman at cmithelman@blcenc.org

Participation Cap: There is a cap of 100 child participants this year due to safety protocol. Once we reach 100 children, registration will be closed.

Optional donation to VBS: We will be accepting additional donations in the payment section below and through the blcenc.org website for VBS scholarships or supplies.

Please complete this form and pay:

Via check to: St. Andrew's Episcopal Church, Attn. VBS, 890 Balour Dr., Encinitas, Ca 92024.

OR:

Online by scanning the QR Code below or Open This Link in a new browser window and choose Vacation Bible School from the drop down menu.

Snacks: Please provide a daily snack and water bottle for your child. We will be outdoors most of the day and need to stay hydrated, we’ll have filling stations around campus.

Volunteers: We are recruiting adult and teen-age volunteers. If you would like to help, please let us know!

Contact: Constance Mithelman at cmithelman@blcenc.org if you have any questions.
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Bethlehem Lutheran & St. Andrew's Episcopal Churches Present:

Ages 4 years old through 6th grade