Vacation Bible School Registration Form

Saint John's VBS 2023

June 27th - 30th

Tues/Wed/Thurs 9AM - 11:30 AM

Friday 5:30 PM - 8:30 PM

(Friday's camp includes a family BBQ and evening games)

FREE

Open to incoming K-5th grade
STUDENT INFORMATION
Last Name*
First Name*
Birth Date *

MonthDayYear
Date
Gender
Grade completed by June 2023*
Have you previously attended VBS at St. John's?

YesNo
Will your family be able to join us for the Family BBQ on Friday 6/30?

Yes (child + family)NoNot SureOnly my child will attend
If "Yes," how many members of your family?
Home Church (if any)
Street Address*
Street Address Line 2
City*
Postal Code*
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian*

First NameLast Name
Relationship to child*
Phone Number*
Alternate Guardian #1*

First NameLast Name
Relationship to child*
Phone Number*
Alternate Guardian #2

First NameLast Name
Relationship to child
Phone Number
Medical Information
Please list all allergies -- or type "none" if there are none*
Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)*

YesNo
Please list all medical concerns -- or type "none" if there are none*
Additional Information
VBS photos/videos are taken for promotional purposes related to St. John's Lutheran Church and Vacation Bible School. These pictures appear in various media outlets such as the church's newsletter and our Facebook page. NO NAMES WILL BE USED. Do you allow your child to be included in these photos/videos?*

YesNo
By submitting this form, I ackowledge I have read and understand the above information.
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Saint John's VBS 2023