VBS Registration Name Student Information Number Registering OneTwoThree Student One Student First Name * Student Last Name * Nickname Age * 3 4 5 6 7 8 9 10 11 12 Gender GirlBoy Grade Going Into * N/A PK K 1st 2nd 3rd 4th 5th 6th Allergies Medical Issues or Special Needs Medical Release * I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me. Photo Release I hereby grant St Pauls Free Lutheran Church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied. Parent/Guardian Information First Name * Last Name * Address * City * State * Zip * Email * Phone Number * Phone Number 2 Emergency Contact & Alternate Pickup Emergency Contact Name * Emergency Phone 1 * Alternate Pickup Name Alternate Pickup Phone General Information
