September 2018  
Upcoming Events
Bible Search
VBS Registration Form



VBS - Splash Canyon

June 3-7, 2018

One form per child, please.


Child’s name: _________________________________________________________________________________

Grade completed ____________ Birthdate ___________________ Age ___________

Parents’ names: _______________________________________________________________________________

Home Address:  _______________________________________________________________________________

Home phone ___________________________________________

Alternate phone(s)_______________________________________



EMERGENCY CONTACT PERSON:  (If parent is unavailable)  _____________________________________________

Relationship to student: _________________________________________________________________________

Emergency Contact Person Phone ________________________________________

Alternate phone(s) ____________________________________________________





Food allergies:   (Please circle)        Yes____No__(List:) _________________________________________________


Permission to administer simple first aid (i.e., bandaids)   Yes       No   (Please initial) _________________________


Medical concerns/conditions:    Yes       No     Explain: _________________________________________________


Family doctor __________________________________________ Doctor’s phone __________________________


Siblings attending VBS (names and ages) ____________________________________________________________


Custody Orders    Yes   or  No    Please indicate who may not pick up any child.______________________________


***************                           *****************                ****************                       ***************


People who may pick up the child/children other than the legal parent/guardian:  (List name and relationship to child/children).  Indicate if this will be on a daily basis.




VBS leaders have permission to photograph/film the minor(s) designated above in any manner or form

for any lawful purpose associated with this VBS program.


Parent’s signature: ___________________________________________________________________________



REGISTRATION FORM. Find this form in the Fill-in PDF Folder on the Director CD. Copyright © 2010 Concordia Publishing House. Permission granted for purchaser to make copies for the year the VBS program is purchased.







Child Release Form for Picking-Up Children

(For use by any individual other than the child's legal parent/guardian,

unless designated as the daily pick-up person on the Registration Form)




Having been listed on the Child's Registration Form as a designated pick-up person by the child/children's parent or legal guardian, I acknowledge that I am picking up ___________________________________________________(name of child or children) from VBS on ____________________________ (date).









Print Name







Contents © 2018 Tressler Memorial / Mt. Zion Free Lutheran Churches | Church Website Provided by | Privacy Policy