Vbs Registration Form (One Form Per Child)

TRINITY   L UTHERAN   C HURCH  

 

 

VBS   R EGISTRATION   F ORM  

       

 

(ONE   F ORM   P ER   C HILD)  

Name:   _ ____________________________________________________________  

Age:   _ _______________            

Grade   e ntering:   _ _____________                            

T   S hirt   S ize   ( specify   y outh   o r   a dult):   _ _____________________________________  

  H ome   C hurch   ( if   a pplicable)   _ ___________________________________________  

Allergies:   _ __________________________________________________________  

Medical   I ssues   o r   s pecial   N eeds:   _ ________________________________________  

Parent   N ame:   _ _______________________________________________________  

Address:____________________________________________________________  

___________________________________________________________________  

Email:   _ _____________________________________________________________  

Home   P hone   N umber:_________________________________________________  

Cell   P hone   N umber:__________________________________________________        

Emergency   C ontact:   _ _________________________________________________  

Emergency   P hone:   _ __________________________________________________  

Attending   D inner?       C heck   w hich   n ights-­‐   M   _ ___   T u   _ ___   W   _ ___   T h   _ ___   F   _ ___  

How   m any   p eople?   _ _______  

 

Medical   R elease:   I   g ive   m y   p ermission   f or   t he   V BS   s taff   t o   a dminister   b asic   f irst   a id   t o   m y  

child   ( named   a bove)   i n   t he   e vent   o f   a n   i njury.   I   u nderstand   t hat   t he   V BS   s taff   w ill   c ontact  

emergency   s ervices   i n   t he   e vent   o f   a   s ignificant   i njury   a nd   a ll   e xpenses   f or   s uch   e mergency  

P arent   S ignature   _ ____________________________  

services   w ill   b e   p aid   b y   m e.  

   

 

Photo   R elease:   I   h ereby   g rant   t he   a bove   n amed   c hurch   p ermission   t o   c opyright   a nd   u se  

photographs/videos   t aken   a t   V BS   o f   t he   m inor   d esignated   a bove   i n   a ny   m anner   o r   f orm   f or  

any   p urpose   l awful   a t   a ny   t ime.   I   w aive   a ny   r ight   t hat   I   m ay   h ave   t o   i nspect   o r   a pprove   t he  

finished   p roduct   o r   w ritten   c opy,   t hat   m ay   b e   u sed   i n   c onjunction   t herewith,   o r   t he   u se   t o  

which   i t   m ay   b e   a pplied.     N o   c hildren’s   n ames   w ill   b e   u sed   w ith   p ictures.    

 

Parent   S ignature______________________________________________________