F5-Refresh...A New Way to VBS
2023 Registration Form for Bethlehem Lutheran, Cedar Falls all age Vacation Bible School adventure!  June 25-28.  Supper is served beginning at 5:00 pm.  Education will begin at 5:45 pm.  Questions or concerns on this form, please call the church office at 319-266-3541.
Email *
Name *
Email where info can be sent regarding VBS Updates *
Cell Phone *
Age Category *
T-shirt Size *
I plan to attend... *
Required
Home Congregation if different from Bethlehem
Emergency Contact Name *
Emergency Contact Phone Number *
Are there any family situations we need to be aware of? (ie. custody issues, other matters, etc)
Please let us know if you approve of the following for the person you are registering (please check all that are true for you) *
Confidential Medical Report*
The information below is requested in case of any illness or accident.  Please check if the person you are registering suffers from any of the following:
 *
Required
Allergies *
Required
Please list any physical or special needs:    
(ie dietary requirements, etc.)
 *
I authorize the leader(s) in charge of Bethlehem's Vacation Bible School, where it is impractical to communicate with me, to arrange for the person registered on this form to receive such medical or surgical treatment as the leader(s) may deem necessary at any time during the activities of Bethlehem Lutheran Church.  I further authorize the use of ambulance and/or anesthetic by a qualified medical practitioner if in his/her judgment it is necessary.  I accept responsibility for payment of all expenses associated with such treatment.  I appreciate that every care will be taken by the leaders and recognize that those connected with the group cannot be held responsible for personal injury, loss, or theft of property affecting the registree.*
My entering my below is my electronic signature that all the above information is accurate to the best of my knowledge.
 *
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