Trinity Lutheran Church
Registration for "Vacation Bible School"
Student Information
page 1 of 4
Name *
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Age
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Entering Grade *
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Preschool
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
Family Information
page 2 of 4
Parent/Guardian(s) Name(s) *
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Best Phone *
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Email *
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Address
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Medical & Emergency Information
page 3 of 4
Allergies or Other Medical Concerns *
required
Medication Required (Emergency Only)
required
Emergency Contact (Name) *
required
Emergency Contact (Phone) *
required
Permission
page 4 of 4
Liability Release
I hereby release Trinity Lutheran Church and its representatives from all liability in the event of accidental injury. In the event that I am not readily available, I, the natural parent or guardian, authorize and consent to all medical, surgical, diagnostic, and hospital procedures as may be performed or prescribed by a physician. Such treatment will only be taken when advisable by a physician to safeguard my child's health. It is understood that every effort will be made to contact the undersigned prior to rendering treatment, but that any of the above treatment will not be withheld if the undersigned cannot be reached.
I Agree to the above statement of release *
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Yes
No
Photo Release
I give permission to Trinity Lutheran Church to use photographs of my child in its public displays or media releases. I understand these photographs will not be sold or used for commercial purposes.
I Agree to the above photo release *
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Electronic Signature of Parent/Guardian *
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* required
