2017 Vacation Bible School




Student First Name:

Middle Initial:

Last Name:

Nickname:

 

Birthday:

 

Gender:

Grade Entering in Fall:

Baptism Date:

(if known)
 
 

Address:

City:

State:

Zip Code:

 

Home Phone:

Home Email:

Parents and/or Guardians:

 

Mother's Cell:

Father's Cell:

Emergency Contact:

Other than listed above

Emergency Contact Phone:

Emergency Phone Type:

 

Primary Contact Method:

 

IS THERE ANYONE NOT AUTHORIZED TO PICK UP YOUR CHILD?

If yes, who?

 

Any food allergies?

If yes, to what?

 

Allergic to any medications?

If yes, to what?

 

Any other allergies?

If yes, to what?

 

Photo Release?

I authorize Lutheran Church of Hope to be able to use photos and images of my child for displays, publicity, website, and general church publications. (Names will not be used unless special permission is granted).

 

T-Shirt size:








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