Child 1: Name
*
First Name
Last Name
Child 1: Date of Birth
*
MM
DD
YYYY
Child 1: School Attending
*
Child 1: Gender
*
Select for Child 1
Male
Female
Prefer not to say
Child 1: Allergies & Behavior Information
*
Please list any allergies, special needs, injuries, behavioral information or any other medical conditions. This will help us determine the correct group and leader for your child's needs.
Music Selection
*
One Per Family (included)
Child 1: T-Shirt (included)
*
Select for Child 1
Child XS (4-6)
Child S (6-8)
Child M (10-12)
Child L (14-16)
Adult S
Adult M
Child 2: Name
First Name
Last Name
Child 2: Date of Birth
MM
DD
YYYY
Child 2: School Attending
Child 2: Gender
Select for Child 2
Male
Female
Prefer not to say
Child 2: Allergies & Behavior Information
Please list any allergies, special needs, injuries, behavioral information or any other medical conditions. This will help us determine the correct group and leader for your child's needs.
Child 2: T-Shirt (included)
Select for Child 2
Child XS (4-6)
Child S (6-8)
Child M (10-12)
Child L (14-16)
Adult S
Adult M
Child 3: Name
First Name
Last Name
Child 3: Date of Birth
MM
DD
YYYY
Child 3: School Attending
Child 3: Gender
Select for Child 3
Male
Female
Prefer not to say
Child 3: Allergies & Behavior Information
Please list any allergies, special needs, injuries, behavioral information or any other medical conditions. This will help us determine the correct group and leader for your child's needs.
Child 3: T-Shirt (included)
Select for Child 3
Child XS (4-6)
Child S (6-8)
Child M (10-12)
Child L (14-16)
Adult S
Adult M
Child 4: Name
First Name
Last Name
Child 4: Date of Birth
MM
DD
YYYY
Child 4: School Attending
Child 4: Gender
Select for Child 4
Male
Female
Prefer not to say
Child 4: Allergies & Behavior Information
Please list any allergies, special needs, injuries, behavioral information or any other medical conditions. This will help us determine the correct group and leader for your child's needs.
Child 4: T-Shirt (included)
Select for Child 4
Child XS (4-6)
Child S (6-8)
Child M (10-12)
Child L (14-16)
Adult S
Adult M
Parent/Care Provider 1: Name
*
First Name
Last Name
Parent/Care Provider : Phone Number
*
(###)
###
####
Parent/Care Provider : Email
*
Parent/Care Provider : Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Calvary Member
*
I would like more information on volunteering for VBS
*
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Physician Name
*
First Name
Last Name
Physician Phone
*
(###)
###
####
Insurance Company Name
*
Insurance Subscriber Name
*
Insurance Policy Number
*
Insurance Group ID
*
I would like to request a scholarship.
*
Financial aid is available for families that need additional support.
Permission and Liability Release Agreement
*
I give my permission for the participant(s) named above top participate in VBS at Calvary Lutheran Church in West Chester, Pennsylvania for the week of July 15-19, 2024. I release Calvary Lutheran Church from any and all liability to me or my child as a result of his/her participation. Also, I understand that Calvary Lutheran Church does not assume any responsibility for loss of, or damage to, personal property of the participant.
Medical Release Agreement
*
In the event of an emergency, in which you are unable to reach me (parent/guardian), in case of injuries, accidents or illness, I give my permission for treatment deemed necessary in consultation between attending emergency physician and the VBS Director for Calvary Lutheran Church. I also release Calvary Lutheran Church and its program staff of liability in the case of accidents or injuries to my child while attending this church event.
Image Release Agreement
*
I hereby grant Calvary Lutheran Church permission to use my likeness in photographs, video recordings or electronic image in any and all of its publications, include website and social media entries, with payment or any other consideration.
