Print this form and return it to Medo Lutheran Church.
2017 Vacation Bible School (VBS) Registration, Medo Lutheran Church
Cost for VBS this year is $5.00 per child. Please contact the church if you need assistance with this.
Parents name ______________________________________________________________________________
Address __________________________________________________________________________________
___________________________________________________________________________________
Cellphone number ________________________________ Do you text? Circle one Yes No
Home number _____________________________ Emergency contact name & # _______________________
Email ____________________________________________________________________________________
What are you willing to volunteer for this VBS year _______________________________________________
__________________________________________________________________________________________
Child 1 First name ___________________________ Last name _____________________________________
School grade this fall ______ Birthday ________________ Age this fall _______ Baptismal date _________
School Name ________________________________________________
Child 2 First name ___________________________ Last name _____________________________________
School grade this fall ______ Birthday ________________ Age this fall _______ Baptismal date _________
School Name ________________________________________________
Child 3 First name ___________________________ Last name _____________________________________
School grade this fall ______ Birthday ________________ Age this fall _______ Baptismal date _________
School Name ________________________________________________
I give permission for any pictures or video taken of my child to be used for promotional purposes.
Authorization for Treatment: I hereby give permission to Medo Lutheran Church to provide
routine health care in case of an emergency as well as necessary transportation for my child.
I understand I will be contacted if my child needs medical treatment at a clinic or hospital.
In the event I cannot be reached in an emergency, I hereby give permission to the physician
selected by the church to secure and administer treatment.
Signature of Custodial Parent or Guardian: ______________________________________________________
Date: __________________
Please list those who are authorized to pick my child(ren) up from Sunday school at Medo Lutheran Church.
__________________________________________________________________________________________
__________________________________________________________________________________________
Please comment on any allergies/special needs your child may have below.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Cost for VBS this year is $5.00 per child. Please contact the church if you need assistance with this.
Parents name ______________________________________________________________________________
Address __________________________________________________________________________________
___________________________________________________________________________________
Cellphone number ________________________________ Do you text? Circle one Yes No
Home number _____________________________ Emergency contact name & # _______________________
Email ____________________________________________________________________________________
What are you willing to volunteer for this VBS year _______________________________________________
__________________________________________________________________________________________
Child 1 First name ___________________________ Last name _____________________________________
School grade this fall ______ Birthday ________________ Age this fall _______ Baptismal date _________
School Name ________________________________________________
Child 2 First name ___________________________ Last name _____________________________________
School grade this fall ______ Birthday ________________ Age this fall _______ Baptismal date _________
School Name ________________________________________________
Child 3 First name ___________________________ Last name _____________________________________
School grade this fall ______ Birthday ________________ Age this fall _______ Baptismal date _________
School Name ________________________________________________
I give permission for any pictures or video taken of my child to be used for promotional purposes.
Authorization for Treatment: I hereby give permission to Medo Lutheran Church to provide
routine health care in case of an emergency as well as necessary transportation for my child.
I understand I will be contacted if my child needs medical treatment at a clinic or hospital.
In the event I cannot be reached in an emergency, I hereby give permission to the physician
selected by the church to secure and administer treatment.
Signature of Custodial Parent or Guardian: ______________________________________________________
Date: __________________
Please list those who are authorized to pick my child(ren) up from Sunday school at Medo Lutheran Church.
__________________________________________________________________________________________
__________________________________________________________________________________________
Please comment on any allergies/special needs your child may have below.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________