Eisleben Stellar VBS 2023(Sun, July 23rd - Tues, July 25th)
Registration Form
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Email *
Registration for a child, youth worker, or adult worker? *
Name *
Age *
Gender *
Birthdate *
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Grade Completed in May 2023 *
Home address *
Name of a special friend your child might light to be with:
Legal Parent/Guardian 1 - Name, Address (if different from above) Email and Phone Number *
Legal Parent/Guardian 2 - Name, Address (if different from above), Email and Phone number
Location where a parent/legal guardian expects to be during the hours of VBS. *
Emergency Contact Name & Phone Number DURING VBS *
2nd Emergency Contact Name & Phone Number DURING VBS *
It is expected that only the parent or guardian listed above check in and check out with each child's leader face to face. Only legal guardians listed above will have pick-up & drop-off permission unless specified in writing. Does your child have permission to travel to and from VBS on bike or foot? *
Name of church you currently attend
How did you hear about our VBS
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Does Eisleben Lutheran Church have permission to use your child's photograph publicly? Images may be used in print publications, online publications, presentations, websites and social media. I also understand that no royalty, fee or other compensation shall become payable to me, by reason of such use. *
In case of emergency, attempts will be made to contact the registered parent/guardians by the VBS leadership. While your student attends VBS parents/guardians MUST be accessible at one of the phone numbers that have been listed. A call to 911 will be made in case of emergency. *
Doctor's Name *
Doctor's Phone Number *
Dentist's Name *
Dentist's Phone Number *
To assist us in keeping your child safe and healthy, please list the students special needs, medical conditions, medications being taken or other helpful considerations. *
Allergies and Food Restrictions - if none, type none *
Hospital Preference *
Participant Behavior Expectations: Our main objective for VBS is to share God's love! In order to provide a safe environment for your student and others, we have the following rules:· Show respect for others· Keep hands, feet, and objects to yourself· Be a good listener· Follow directions the first time they are given. *
Discipline Policy: Disruptive and aggressive behavior will not be tolerated. If there is a problem, the student will be removed from the activity, placed in a time-out area, until they can resume activity without disruption or aggressive behavior. The parent/guardian of the student will be notified at the end of the day’s VBS session unless the student is unable to gain self-control in which case we will call listed parents/guardians to pick up the student. *
Permission & Consent Authorization: I understand and agree to the use of the behavior expectations and discipline policy listed above. I will state the expectations to my student prior to participating and support it. I give my consent for the use of basic first aide by our staff/volunteers in case of minor injury and permission to seek additional emergency medical treatment in my absence. I understand that in such case reasonable attempts would first be made to contact me, time and conditions permitting and that I am responsible for all costs incurred for his/her injury and treatment. *
Parents Name/Date to serve as signature. *
If registering as a youth/adult worker what would you like to help with?
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