St. Mark's Vacation Bible School Registration 2024
Caregiver Information
This person serves as the primary contact for all VBS communication.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number
Secondary Number
To be used in case of emergency
Email
*
Registration confirmation and all other VBS information will go to this email.
Relationship to Child
*
Mother
Step Mother
Father
Step Father
Grandma
Grandpa
Other
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Student Information
Register only children in a single family. Caregivers of extended family and friends should register separately.
Child #1 Name
*
First Name
Last Name
Child #1 Birth Date
*
-
Month
-
Day
Year
undefined
Child #1 School Grade (in May 2024)
*
Please Select
Preschool
Kindergarten
First
Second
Third
Fourth
Fifth
Child #1 Gender
*
Please Select
Male
Female
Does this child have any allergies, medical conditions, or special needs we should know about?
Would you like to register another child?
Please Select
Yes
No
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Child #2 Name
*
First Name
Last Name
Child #2 Birth Date
*
-
Month
-
Day
Year
Date
Child #2 School Grade (in May 2024)
*
Please Select
Preschool
Kindergarten
First
Second
Third
Fourth
Fifth
Child #2 Gender
*
Please Select
Male
Female
Does this child have any allergies, medical conditions, or special needs we should know about?
Would you like to register another child?
Please Select
Yes
No
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Child #3 Name
First Name
Last Name
Child #3 Birth Date
-
Month
-
Day
Year
Date
Child #3 School Grade (in May 2024)
Please Select
Preschool
Kindergarten
First
Second
Third
Fourth
Fifth
Child #3 Gender
Please Select
Male
Female
Does this child have any allergies, medical conditions, or special needs we should know about?
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Medical Release
I/We the undersigned have legal custody of the child(ren) listed in this form, who is a minor, and have given our consent for him/her to attend events being organized by St. Mark’s Lutheran Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. I/we affirm that the information provided in this form is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the church staff.
*
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Photo/Video Permission
I grant permission to St. Mark’s Lutheran Church to use the image of my child(ren) taken at VBS.Such use includes the display, publication, transmission or otherwise use of photographs, images and/or video taken of my child (excluding their name) for use in materials that include printed brochures and newsletters, videos, digital images, or St. Mark's social media accounts.
*
Yes, I grant permission.
Please do not use my child's image in any St. Mark's publications.
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Are you interested in volunteering for this year's event? If so, we will contact you to find the best fit for your skills.
YES! Please reach out to me.
Thanks, but not this year.
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