Vacation Bible School Child Registration

Parent Information

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Cell Phone Number

Home Phone Number

Email

Additional Information

Child Information

Child First Name

Child Last Name

Gender

Birthdate

Age

Grade Child Is Entering Into

Allergies

Medical Conditions

Special Needs or Accomodations Needed

Child Pick-Up Information

Name of Adult Picking Up Child Each Day

Name of Secondary Adult Who May Pick Up Child

Children may only be picked up by one of the adults named above. Adults are required to show a photo ID during pick-up. Children will not be sent home with any unverified adults.

You can also name a person who is especially prohibited from picking up your child (due to custody, etc). Our volunteers will make special note of these individuals and will inform you if these individuals attempt to contact your child.

This person or persons MAY NOT pick up my child

Primary Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Phone Number

Secondary Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Phone Number

Photography Waiver

During VBS, photos and video may be taken of the group and/or individual children. These photos may be shared on social media and/or the church website. By checking the box below, you consent to these photos and/or videos being taken of your child.

I give Hope Lutheran Church permission to take photos and/or video of my child and share them on social media, the church website, or other Hope Lutheran Church publicity platforms.

Yes

Signature