VBS Registration Form

The St John Lutheran Church 2024 Vacation Bible School will be held June 23rd - 27th from 5:30 p.m. to 8:00 p.m.

Child 1 Name

First Name

Last Name

Age

Birthdate

YYYY

Medications, allergies, or medical conditions

VBS Group (to be completed by VBS Registration Crew)

Child 2 Name

First Name

Last Name

Age

Birthdate

YYYY

Medications, allergies, or medical conditions

VBS Group ( to be completed by VBS Registration Crew)

Child 3 Name

First Name

Last Name

Age

Birthdate

YYYY

Medications, allergies, or medical conditions

VBS Group (to be completed by VBS Registration Crew)

Child 4 Name

First Name

Last Name

Age

Birthdate

YYYY

Medications, allergies, or medical conditions

VBS Group (to be completed by VBS Registration Crew)

Mother's Name

First Name

Last Name

Mother's Cell Phone

(###)

###

####

Mother's Email

Mother's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father's Name

First Name

Last Name

Father's Cell Phone

(###)

###

####

Father's Email

Father's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Information

Names of people authorized to pick-up child(ren)

Parent/Guardian Signature

Please read the below releases and sign here if you agree. You will also be required to sign a paper copy of the release form when dropping off your child(ren) for the first day.

Parent/Guardian Printed Name

Date

YYYY

I agree to the St. John Lutheran Church release statement below.

Parents/Guardians: Please read the releases below before signing and submitting the registration form above. This release is valid until redacted in writing by parents.

RELEASE: To the fullest extent permitted by law, I release St. John Lutheran Church, it’s trustees, officers, directors, employees, agents, and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless.

St John Lutheran Church, it’s trustees, officer, directors, employees, agents, and representatives from any claims arising out of my minor child’s participation in the activity.

GENERAL: I give my consent for my child(ren) to attend meetings, activities, and events, both on site and off site. I will be provided specific event information in advance of any activity that will be taking place off-site.

MEDICAL: In the event of a medical emergency and when a contact cannot be made in a timely manner to me and/or the emergency contact listed, I give my permission for my child(ren) to received appropriate medical attention. In the even of an unforeseen emergency or any accidents, I release St John Lutheran Church, it’s employees, volunteers, and all those related to it, from any liability. I have provided emergency contact numbers and am assured that I will be contacted as soon as possible in the event that there is an emergency.

TRANSPORTATION: Should transportation be needed, I agree to allow my child(ren) to ride with children leaders, another staff member, a volunteer of the church, or a parent. Appropriate safety standard will be maintained and children will always be provided seat belts. If no such permission is granted, I agree to transport my child(ren) to and from the offsite event. I understand that it is my child(ren)’s responsibility to wear his/her seat belt.

LEAVING THE CHURCH: I give permission for my child(ren) to leave the church when supervised by the children’s/youth leaders for appropriate activities related to church (such as visiting a nearby shop or business, participating in a scavenger hunt, go on a walk, etc.)

PHOTOGRAPH RELEASE: Occasionally photos & videos may be taken during VBS, Sunday school, worship, youth group events, or other church activities. I grant permission for St John Lutheran Church to post photos and videos including my child(ren) on it’s website or in other church publications/media.

St John Lutheran Church, 111 Walnut Street, PO Box 46, Boiling Springs, PA 17007

VBS Registration Form

Thank you!

Service Times