Hope Lutheran VBS July 26-30

Masks will NOT be required at VBS.

Child's Name

Child's Birthdate

Grade COMPLETED this past school year:

3 year old 4 year old 5 year old Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Address

Parent/Guardian #1 Name

Cell Phone

Work Phone

Home Phone

Email (we do not sell or spam emails but will use this to correspond the week of VBS)

This address will receive a confirmation email

Parent/Guardian #2 Name

Cell Phone

Work Phone

Emergency Contact (other than parent/guardian)

Relationship to Child:

Emergency Contact Cell Phone

Emergency Contact Alternate Phone

Medical Insurance Company

Policy Holder's Name

Policy/Certificate Number

Physician Name

Physician Phone

Does your child have any allergies?

Yes No

If yes, please list and/or explain type of allergies and reaction:

Please list any medications being taken, medical problems, or other pertinent information including physical, mental, or psychological conditions that may require medication, treament or restrictions:

What days will your child be attending VBS Day Camp? (check all that apply)

Monday Tuesday Wednesday Thursday Friday

Friday July 30th is an extended VBS day until 4pm. Closing program is at 4pm.
Students will be watching a movie in the afternoon and then at 4pm all VBS attendees, siblings, friends and family are invited to come and see our students showcase the songs, projects and crafts they have completed during the week. Following the closing 4pm program a FREE grill out will be provided for parents, family members, and friends as we wrap up the week and enjoy fellowship. This will take place immediately following the closing program (around 4:30pm). So join us as we take care of dinner for your family and you enjoy the end of a great week.

I hereby enroll and give permission for my child to participate in the planned activities of Hope Lutheran Church VBS Day Camp. I understand I am responsible for transportation to and from Hope Lutheran Church Day Camp.

I agree I DO NOT agree

Photo Image Release: As a participant in a Hope Lutheran Church event, I give permission and consent to allow photos, and videos, to be taken of the above mentioned individual during the VBS session. I further give consent that any such images or videos may be published in a variety of ways and used to illustrate and promote Hope Lutheran Church.

I agree I DO NOT agree

Authorization for Treatment: I hereby authorize the Hope Lutheran Church staff and volunteers to administer medications and first aid as deemed necessary as well as authorize the medical personnel selected by Hope Lutheran Church Staff to provide emergency medical care by medical staff to hospitalize, secure treatment for, order injection, anesthesia, blood transfusions, or surgery, and to release any records necessary for insurance purposes as well as provide or arrange necessary related transportation for the above named participant. This form may be photocopied.

I agree I DO NOT agree

All students must bring their own sack lunch each day.

I understand and will provide lunch for my child.

T-Shirt Size

Youth Size Xsmall Youth Size Small Youth Size Medium Youth Size Large Adult Small Adult Medium Adult Large Decline Participant Shirt

*Hope Lutheran Church is committed to offering a week of VBS ministry FREE to participants. We believe everyone should have access to this fun week of faith formation. If you would like to help us continue to fulfill our mission of sharing God's love through this free summer VBS Day Camp please consider making a donation. All funds received help defray VBS costs such as supplies, snacks, etc.

Donation* and/or shirt payment ($6.50/shirt)

Hope Lutheran Church
16898 Michael Ave
Hastings, MN 55033
651-480-2273

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Hope Lutheran VBS July 26-30

Description

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