Vacation Bible School with St. Andrews Lutheran Church (July 12-16, 2021)

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GENERAL INFORMATION

(applies to all children enrolled in this form)

Parent/Guardian Names: *

Phone # we can reach you every night: *

Mailing Address (street, city, state, zip): *

Email (if you use email):

Home church (if you belong to one):

Names and phone numbers of those authorized to pick up the child(ren) listed in this form: *

This will be a primarily outdoor event. It is also a "masks not required" event, which must be acknowledged for participation. (You are welcome to wear a mask, but masks will NOT be required of any participants or volunteers.) If you do not feel safe enough with this approach, we welcome you to attend next year on June 13-17, 2022 when we expect the COVID-19 pandemic to be more fully under control. *

I acknowledge that for staff and participants of this event, masks are allowed but not required.

Permission to Attend: *

I give permission for my child(ren), named below in this form, to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church.

Medical Release: *

I give my permission for the VBS staff to administer basic first aid to the child(ren), listed below in this form, in the event of an injury. I understand the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Photo Release:

I hereby grant St. Andrews Lutheran Church permission to copyright and use photographs/videos taken at VBS to the minors designated (below in this form) in any manner or form for any purpose lawful at any time.

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Service Club** Permission to Participate: *

I give permission for the 6th-8th grade child(ren), listed below in this form (for the Service Club**), to attend and be transported by car to activities at the Stockton Homeless Shelter and/or Gospel Rescue Mission Center and the Lincoln 1&5 Pool during the week of July 12-16, 2021.

I am not enrolling any 6th-8th grade child(ren) in this form

NOTE: Below, please register the child(ren) for the grade they will be attending in this upcoming 2021-2022 school year.

Child #1 Name: *

Child #1 Birthday: *

YYYY

Grade (Child #1): *

6mo-2yrs

3yrs

4/5yr-K

1st

2nd

3rd

4th

5th

Service Club (6th-8th)**

Child #1 allergies/medical concerns: *

No known allergies/medical concerns for this child.

Other:

(skip if this does not apply for child #1) This child would like to be in the same group as:

CHILD #2 (Skip this entire section if you are only enrolling one child.)

Child #2 Name:

Child #2 Birthday:

YYYY

Child #2 Grade:

6mo-2yrs

3yrs

4/5yr-K

1st

2nd

3rd

4th

5th

Service Club (6th-8th)**

Clear selection

Child #2 allergies/medical concerns:

No known allergies/medical concerns for this child.

Other:

Clear selection

(skip if this does not apply for child #2) This child would like to be in the same group as:

CHILD #3 (Skip this entire section if you are only enrolling one or two children.)

Child #3 Name:

Child #3 Birthday:

YYYY

Child #3 Grade:

6mo-2yrs

3yrs

4/5yr-K

1st

2nd

3rd

4th

5th

Service Club (6th-8th)**

Clear selection

Child #3 allergies/medical concerns:

No known allergies/medical concerns for this child.

Other:

Clear selection

(skip if this does not apply for child #3) This child would like to be in the same group as:

PLEASE USE THE "SUBMIT" BUTTON BELOW. THE INFORMATION YOU HAVE ENTERED ABOVE WILL NOT REGISTER UNTIL YOU HAVE ACTUALLY SUBMITTED THE FORM THIS WAY.

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