2025 VBS | St. John Lutheran Church & School

Parent First Name *

Parent Last Name *

Parent Cell Phone *

Parent Email *

Address 1 *

Address 2

City *

State *

Zip / Post Code *

Home Church Affiliation *

First Name *

Last Name *

Phone *

Relationship to child(ren) *

First Name *

Last Name *

Grade entering in Fall 2025 *

Preschool 4
Young 5/Kindergarten
First
Second
Third
Fourth
Fifth
Sixth

Please list any allergies:

Please list any medical concerns:

First Name

Last Name

Grade entering in Fall 2025

Preschool 4
Young 5/Kindergarten
First
Second
Third
Fourth
Fifth
Sixth

Please list any allergies:

Please list any medical concerns:

First Name

Last Name

Grade entering in Fall 2025

Preschool 4
Young 5 / Kindergarten
First
Second
Third
Fourth
Fifth
Sixth

Please list any allergies:

Please list any medical concerns:

First Name

Last Name

Grade entering in Fall 2025

Preschool 4
Young 5 / Kindergarten
First
Second
Third
Fourth
Fifth
Sixth

Please list any allergies:

Please list any medical concerns:

By checking the box below, I understand that photos will be taken as part of this event. All photos may be used by St. John, including posting them to social media. St. John will never identify the student in the photo in print or on social media. *

By checking the box below, I understand that if neither parent/guardian can be reached in the event of an emergency, I authorize all medical, surgical, x-ray, laboratory, anesthesia, and other medical and/or hospital procedures may be performed or prescribed by the attending physician and/or paramedics for my child, and I waive my right to informed consent of treatment. *

By checking the box below, I release St. John Lutheran Church & School and individuals acting on their behalf, from liability in case of accident involving my child during activities related to St. John Lutheran Church & School so long as normal safety procedures have been taken. *