Immanuel Lutheran Church
                     of Almelund, Minnesota

         

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INTERGENERATIONAL VACATION BIBLE SCHOOL FAMILY REGISTRATION

July 30—August 3, 2017

Parent or Guardian:______________________________________ Attending VBS? Y N Food allergies? Y / N List:___________________________________________________________

Medical concerns? Y / N List:___________________________________________________________

Parent or Guardian:______________________________________ Attending VBS? Y N

Food allergies? Y / N List:____________________________________________________________

Medical concerns? Y / N List:__________________________________________________________

Address:_________________________________________________________________

email(s): ________________________________________________________________

home phone:____________________ alternate phone:____________________________

Family Home Church ______________________________ City _____________________

Family Doctor & Hospital ________________________________Phone: _______________

Emergency contact:_________________________ Relationship to student:_____________

home phone:_____________________ alternate phone:____________________________

Who may pick your child(ren) up:______________________________________________ Photo Release I give permission for Immanuel Lutheran Church to lawfully use, publish, or disclose in newsletter, brochures, posters, website, or other media, any photographs, videos, audios, or other material in which my child may have appeared, spoken, or written or otherwise been represented. No names shall be attached to any media used. (Permission granted for one year from date of signature unless otherwise revoked by signer.)

Agreed _____________________________________________ Date ____________

(Parent/Guardian’s Signature)

Child’s Name_________________________________________________ Gender M F

Birthday _________________________ age__________ grade completed_____________

Food allergies? Y / N List:__________________________________________________

Medical concerns? Y / N List:_________________________________________________

Transportation Needed? Y / N Attendance: 1 2 3 4 5

Notes:

(More members of family on back side of form)