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VBS2024
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Child Registration Form
Parent / Guardian Information
First Name
Last Name
Email
Phone Number
Address
Apartment, suite, etc.
City
State
Postal / Zip Code
Emergency Contacts (not listed above)
Who is authorized to pick up your child(ren) from VBS?
How many children are you registering today?
One
Two
Three
Four
Name of Child 1
Date of Birth
Gender
Grade in Fall 2024
4 year old preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
T-Shirt Size
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2X
Does the child have any allergies?
Yes
No
Please list all food and environmental allergies:
Are there any medical concerns we should be aware of?
Yes
No
Please include all medical concerns:
Name of Child 2
Date of Birth for Child 2
Gender of Child 2
Grade in Fall 2024 for Child 2
4 year old preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
T-Shirt Size of Child 2
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2X
Does Child 2 have any allergies?
Yes
No
Please list all food and environmental allergies for Child 2:
Are there any medical concerns we should be aware of for Child 2?
Yes
No
Please include all medical concerns for Child 2:
Name of Child 3
Date of Birth for Child 3
Gender of Child 3
Grade in Fall 2024 for Child 3
4 year old preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
T-Shirt Size of Child 3
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2X
Does Child 3 have any allergies?
Yes
No
Please list all food and environmental allergies for Child 3:
Are there any medical concerns we should be aware of for Child 3?
Yes
No
Please include all medical concerns for Child 3:
Name of Child 4
Date of Birth for Child 4
Gender of Child 4
Grade in Fall 2024 for Child 4
4 year old preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
T-Shirt Size of Child 4
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2X
Does Child 4 have any allergies?
Yes
No
Please list all food and environmental allergies for Child 4 :
Are there any medical concerns we should be aware of for Child 4?
Yes
No
Please include all medical concerns for Child 4:
I give permission for photographs or videos of my child(ren) taken as part of First Lutheran VBS 2024, to be used now or in the future for the purpose of internal and external communications, including advertising and marketing as well as posted on Social Medical account(s) including Facebook, Instagram, and the website. I understand I can withdraw this consent at any time by advising the First Lutheran office in writing.
Agree
Disagree, do not use my child's photos or videos
In the event I cannot be reached, I hereby give permission for First Lutheran Church VBS to secure proper and necessary treatment / medical attention for my child(red) as named on this form.
I agree
I disagree, do not seek emergency medical treatment without my consent.
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