2019 VBS Signup Online Form

In conjunction with English Lutheran and St Paul Lutheran, Zion will host a 2019 Vacation Bible School on July 15-18 from 9am to noon each day.

Complete the form below and be sure to hit the "Submit" button to email your child's registration form to Zion.

* Indicates required field

Child's Name *

First

Last

Age *

Grade Entering This Fall *

Child's T-Shirt Size *

Gender *

Home Congregation (if applicable) *

Parent/Guardian Name *

First

Last

Willing to volunteer to help? Choose all that apply *

Leader Aide No Thanks

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone *

Cell Phone *

Other Phone Number *

Email *

Emergency Contact Name (other than parent/guardian) *

First

Last

Phone Number *

Alternate Person Picking-up Child *

First

Last

Phone Number *

List any allergies or medical needs that the child has *

List anything special you'd like us to know about your child *

Optional: It would be nice if my child is placed in the same group as (other child's name) *

First

Last

A daily offering will be collected for a local mission. Please bring a canned good each day for the Food Cupboard.

--Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

--Photo Release: I hereby grant the above named church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

--Permission to Attend: I give permission for my child (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church, and that all registration information will be removed from the hosting site by December 31 of this year.

Print this page before hitting Submit to retain copy of completed form

Submit

557 Perry highway, Harmony Pa. 16037

724-452-8886

zion557@zoominternet.net