Please provide the following Adult Contact information:

First & Last Name:
Street Address:
City, State, Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail Address:

If Registering, Enter the Names, Ages and Grades of the Child(ren) Attending:

	Name:	Age:	Grade Just Finished:
Child 1
Child 2
Child 3
Child 4
Child 5

	Name:	Phone:
Family Doctor
Emergency Contact

Does your Child have any allergies or other medical conditions that we need to know about?

By having a checkmark in this box, I agree to the following:

I, the contact provided above, herby give permission for the student(s) registered above to attend St. John Lutheran Church – Vacation Bible School and with this signed agreement, absolve the staff of St. John Lutheran Church, the Vacation Bible School volunteers and any and all members of it’s governing boards of any responsibility for the safety, welfare, health, and well-being of the child(ren) named above, beyond such matters as may be called reasonable care for child(ren) in the custody of the staff and volunteers and subject to the staff and volunteer’s clear instructions, and assume personally and exclusively all responsibility and liability for any accident, injury, etc., which may occur to the child(ren) named above during the time of the specific activity as set forth at the beginning of the paragraph.

If Volunteering, Please select all that apply:

Prior to VBS, I would be willing to serve in the following areas:
	Pray for teachers, helpers and students
	Prepare craft materials
	Work on decorations
During VBS, I would be willing to serve in the following areas:
	Pray for teachers, helpers and students
	Cub Control (Babysitting)
	Preschool Pals (Preschool Helpers) – need approx. 4-5 people
	Campfire Story Tellers – need approx. 5-6 people
	Circle Guides (Small Group Leaders) – need approx. 20 people
	Campground Sanitation Crew (Clean-up)
	Wilderness Crafts (Crafts)
	Trek Tunes (Music)
	Backpack Snacks (Refreshments)
	Survivor Games (Games) – need approx. 5-6 people

Additional Comments/Things we should know: