Kids Day Camp/VBC Registration Form

Parent/Guardian - Emergency Contact Information
Primary Contact Person*

First NameLast Name
Relationship*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Unhoused
Phone Number*
Please enter a valid phone number.
Email*
Secondary Contact
Name 2*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email
Home Church Name (If applicable)
Authorized person (not including listed emergency contacts) who can pickup the child on dismissal

First NameLast Name

Suggested Donation of $20 per child

USDDescription

Credit Card

Apple Pay

Google Pay

Agreement
1. I allow my child/ children to participate in the Bethesda Lutheran Vacation Bible Camp.
2. All fees are non-refundable.
3. I authorize Bethesda Lutheran volunteers to conduct first aid and medical care in the event of an emergency situation. I agree to pay for all medical care expenses and costs incurred in a situation where medical care is necessary.
4. I release Bethesda Lutheran Church from any liabilities that might happen during the activity and hold them harmless in the event of damages, injuries, or accidents.
5. I confirm that all information in this form is accurate and true to the best of my knowledge.
I agree to the above terms.*

I agree
I would like to opt out of having my child/children's photos and videos taken during VBC and posted to Bethesda Lutheran's social media account or used for promotional purposes.

Opt Out
Parent/Guardian Signature*

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Date Signed*

MonthDayYear
Date
Should be Empty:

Child 1