VBS 2018

Vacation Bible School 2024

Join us for a fun, safe week, where we learn about our relationship with Jesus!
Up to 5 children per registration form. If you have more than 5 children in one household please fill out this form and resubmit a second registration using a different primary email.
Student Information
First Name*
Last Name*
Nickname
Gender*

MaleFemale
Birth Date*

MonthDayYear
Grade in 2024-25*
Age on June 1, 2024*
T Shirt Size
Date of Last Tetanus shot*

MonthDayYear
Date
Does your child have any anaphylactic (life threatening) reaction to any allergen*
If yes, please list allergen and reaction.
Any other allergies or food sensitivities? (please list and reaction)
Medication or other medical conditions we should be aware (please specify)
Activity Restrictions or other information
Friend Request
Siblings*

yesno

Sibling (Participant #2)
Name

First NameLast Name
Nickname (optional)
Gender

MaleFemale
Birthday

MonthDayYear
Date
Grade in 2024-25
Age on June 1, 2024
T Shirt Size
Date of last tetanus

MonthDayYear
Date
Does your child have any anaphylactic (life threatening) reaction to any allergen*
If yes, please list allergen and reaction.
Any other allergies or food sensitivities? (please list and reaction)
Medication or other medical conditions we should be aware (please specify)
Activity Restrictions or other information
Friend Request
Another Sibling?

YesNo

Sibling (Participant #3)
Name

First NameLast Name
Nickname (optional)
Gender

MaleFemale
Birthday

MonthDayYear
Date
Grade in 2024-25
Age on June 1, 2024
T Shirt Size
Date of last tetanus

MonthDayYear
Date
Does your child have any anaphylactic (life threatening) reaction to any allergen*
If yes, please list allergen and reaction.
Any other allergies or food sensitivities? (please list and reaction)
Medication or other medical conditions we should be aware (please specify)
Activity Restrictions or other information
Friend Request
Another Sibling?

YesNo

Sibling (Participant #4)
Name

First NameLast Name
Nickname (optional)
Gender

MaleFemale
Birthday

MonthDayYear
Date
Grade in 2024-25
Age on June 1, 2024
T Shirt Size
Date of last tetanus

MonthDayYear
Date
Does your child have any anaphylactic (life threatening) reaction to any allergen*
If yes, please list allergen and reaction.
Any other allergies or food sensitivities? (please list and reaction)
Medication or other medical conditions we should be aware (please specify)
Activity Restrictions or other information
Friend Request
Another Sibling?

YesNo

Sibling (Participant #5)
Name

First NameLast Name
Nickname (optional)
Gender

MaleFemale
Birthday

MonthDayYear
Date
Grade in 2024-25
Age on June 1, 2024
T Shirt Size
Date of last tetanus

MonthDayYear
Date
Does your child have any anaphylactic (life threatening) reaction to any allergen*
If yes, please list allergen and reaction.
Any other allergies or food sensitivities? (please list and reaction)
Medication or other medical conditions we should be aware (please specify)
Activity Restrictions or other information
Friend Request

Parent or Legal Guardian Information
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd Parent/ Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email (if different)
example@example.com
Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Info

An additional individual we can contact if there is an emergency and the parent/guardians listed above are not available.
Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Allowed to also pick up/drop off*

yesno
Additional Authorized individuals who have permission to pick up or drop off. Please list name, relationship, and phone number.

Registration Information
Connections to Trinity Lutheran Church

MemberAttend(ed) PreschoolAttend(ed) Good ShepherdAttend(ed) CampOther
VBS Photo Release
I understand that photos will be taken of children during VBS. These pictures will be used for individual photos for children as well as we also may use photos on promotional materials both print and web-based. I give consent for my child's photo to be used understanding that no names, ages, or individual information will be shared along with photos. As a parent, I will not tag my own child or anyone elses on the church social media pages.
I understand my child's photo will be taken and used to take home activities as well as on campus promotions.
I understand and agree to the social media policy.
Emergency Authorization

I understand that having my children participate in Trinity Lutheran Church's VBS there is a risk of injury. I hereby give my consent to Trinity Lutheran Church and its representatives to provide all appropriate medical and/or dental care to the above registered children. If deemed necessary Trinity Lutheran Church's staff or representative will consult emergency medical or dental care. This care may be given under whatever conditions are necessary to preserve life, limb, or well being of my child(ren). And give my consent and authorization for medical treatment. Concerted effort will be made to contact parent/guardian before any treatment is given. I agree to assume any financial liability for medical services rendered. Any ongoing or regular medical treatments must be prescribed by a licensed physician (MD) or dentist (DDS) before they can be administered to child during camp or extended care hours.
I understand and agree to the emergency authorization
By placing initials below and hitting submit, you agree that you are the parent or legal guardian of the above named children(s), and are over the age of 18. I certify that minor child(ren) has my permission to attend camp and participate in all activites, unless previously stated. I also verify my agreement, unless specified, to the medical authorization, and registration fee expectations
Electronic signature, please initial*
Registration Fee

I understand that the non-refundable registration fee is due upon registration. Please submit your fee to our Church office or if you would prefer you may also mail your registration fee payable to Trinity Lutheran Church memo: VBS to VBS c/o Trinity Lutheran Church 2949 Alamo St. Simi Valley, CA 93063. Registration fees must be received within 10 business days of submission or registration will be cancelled.
Payment Options

Should be Empty:

Enter coupon

Vacation Bible School 2024

Student Information

Sibling (Participant #2)

Sibling (Participant #3)

Sibling (Participant #4)

Sibling (Participant #5)

Parent or Legal Guardian Information

Emergency Contact Info

Registration Information

VBS Photo Release

Emergency Authorization

Registration Fee