VBS 2024: Breaker Rock Beach
Sunday, June 9 - Thursday, June 13
5:00 - 8:00pm
God's truth never changes or ends!
This is the VBS student/child participant registration form. If you are looking for the youth or adult volunteer form, click here: VBS Volunteer Registration !
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Email *
Student First Name *
Student Last Name *
Nickname
Age *
Gender *
Grade Completed in 2023-2024 School Year *
Parent/Guardian Name *
Home Address *
Street, City, State & ZIP
Primary Phone *
Secondary Phone
Email *
Emergency Contact *
Relationship to Child *
Emergency Contact Number *
Food Allergies *
If yes, what food allergies
Medical Concerns *
If yes, what medical concerns
Name of Siblings Attending VBS
Please fill out registrations for each child.
Church Affiliation
Church Membership At
People who may pick up your children:
Pick up cards will be given at registration table on night 1. If an adult does not have the pick up card, they will not be able to pick up your child(ren).
 *
Pick up phone number *
Evenings Planning to Attend *
Required
Medical Release *
I give permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency expenses will be paid by me.
Required
Photo Release *
I hereby grant Our Redeemer Lutheran Church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any lawful purpose at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.
Required
MEAL FORM
Meals will be available from 5:00-5:30 (please fill out meal form if you plan to attend the meals)
Please select each night you plan to eat: Use Children's or Adult's to help us prepare adequate food.

Children's Meal  
PLEASE INDICATE NUMBER OF CHILDREN ATTENDING MEAL IN 'OTHER' BOX
 *
Required
Adult's Meal
PLEASE INDICATE NUMBER OF ADULTS ATTENDING IN 'OTHER' BOX
 *
Required
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