VBS Registration

1st Child’s Name*: 
Age:   Grade leaving:  
My child will be attending:  VBS Music Camp Both
Allergies/Medical needs:

2nd Child’s Name: 
Age:   Grade leaving:  
My child will be attending:  VBS Music Camp Both
Allergies/Medical needs:

3rd Child’s Name: 
Age:   Grade leaving:  
My child will be attending:  VBS Music Camp Both
Allergies/Medical needs:

4th Child’s Name: 
Age:   Grade leaving:  
My child will be attending:  VBS Music Camp Both
Allergies/Medical needs:

5th Child’s Name: 
Age:   Grade leaving:  
My child will be attending:  VBS Music Camp Both
Allergies/Medical needs:

Parent/Gaurdian Name: 

Address: 

City:  State:   Zip:  

Parent/Gaurdian E-mail: 

Phone 1: 

Phone 2: 

Emergency Contact Name: 

Phone: 

Relationship to child: 

Medical Release: I (We), the parent(s) or guardian(s) of the above listed child(ren) grant permission for our child(ren) to participate in Vacation Bible School at St. Luke’s Episcopal Church and to receive medical treatment if necessary. If I (we) or the listed child care provider or emergency contact cannot be reached, I (we) give our permission to the staff to secure the services of a licensed physician to provide necessary care for my child’s well-being. I (we) also release and agree to hold harmless St. Luke’s Episcopal Church and all its participants from any liability and assume all risk of injury, damage or expenses as the result of participation in activities in Vacation Bible School.

 I Agree I Do Not Agree

Photo Release: I (We) understand that as a participant in St. Luke’s Episcopal’s VBS, my child(ren) may be photographed or videotaped during VBS events. I also understand that these may be used in presentation & promotional materials. I release St. Luke’s Episcopal Church from any and all liability.

 I allow my child(ren) to be photographed/videotaped. I do NOT want my child(ren) to be photographed or videotaped during VBS.