VBS Student Registration Form
St. Andrew Lutheran Church
Student Information
Name
*
First Name
Last Name
Gender
*
Male
Female
Birth Date
*
/
Month
/
Day
Year
Date
Grade just completed
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home church
*
St. Andrew
None
Other
T-shirt size (please also note youth or adult)
*
Emergency Contact
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Medical Information
Please list any food allergies
Please list any medical concerns
Additional Information
St. Andrew Lutheran Church has my permission to use my child’s photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites and/or social media. Do you allow your child to be included in these photos/videos?
*
Yes
No
Submit
Should be Empty: