2017 VBS Student Registration
1. Child’s Name
1st Child’s Grade Completed
1st Child’s Date of Birth
2nd Child’s Name
2nd Child’s Grade Completed
2nd Child’s Date of Birth
3rd Child’s Name
3rd Child’s Grade Completed.
3rd Child’s Date of Birth
4th Child’s Name
4th Child’s Grade Completed
4th Child’s Date of Birth
Parent Name (s)
Parent City, State, Zip
Parent Cell Phone Number
Parent-Additional Phone Number
Emergency Contact Name (other than parent)
Emergency Contact Primary Phone Number
Emergency Contact Secondary Phone Number
Name of Person Responsible for Pick-up
Pick-up Person Primary Phone Number
Allergies: Please list allergies for you children individually.
Special Needs: Please list any special needs for your children individually.
Other Information: Please list any information that needs to be known to the Sunday School coordinators and teachers.
I understand in the event of an emergency medical care becomes necessary, every attempt will be made to contact someone. If unable, I grand the adult volunteers at St. John’s Lutheran Church VBS authorization to secure medical attention. I also give my permission for my child’s photo to be used in promotional materials by St. John’s.
VBS T-shirts are available for purchase this year. Please note size and quantity needed. Sizes available: Child Sm ($7), Child Med ($7), Child Lg ($7), Child XL ($7), Adult Sm ($10), Adult Med ($10), Adult Lg ($10), Adult XL ($10), Adult 2X ($12) or Adult 3X ($12). Please make check payable to St. John’s Lutheran Church to drop off at the church or mail.
Your Email Address
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