St. Paul Lutheran Church of Cumberland, WI
VACATION BIBLE SCHOOL REGISTRATION 2025
(One form per child, please)
*Student First Name: _________________________________________________________
*Student Last Name: _________________________________________________________
Nick Name: _________________________________
*Age: ______________________________________
*Grade just completed: _____________________________
Home Church (if applicable): ___________________________________________________
*Allergies: __________________________________________________________________
*Medical Issues or Special Needs: _______________________________________________
*Parent Name: ______________________________________________________________
*Address: _________________________________________________________________________
*City: _____________________________________________________________________
*State:___________________________________________________________________________
*Zip: ______________________________________________________________________
*Email: ____________________________________________________________________
*Home Phone Number:_______________________________________________________
Cell Phone Number:__________________________________________________________
Other Phone Number: ________________________________________________________
*Emergency Contact Person____________________________________________________
*Emergency Phone: __________________________________________________________
Alternate Pickup Person: ______________________________________________________
Alternate Pickup Phone: _______________________________________________________
General Information: __________________________________________________________
___________________________________________________________________________
T-Shirt Size (youth sizes): ___XS ___S ___M ___L ___XL
*Please Check If You Will Be Joining Us for Dinner Each Night ___YES or ___NO
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 AND to travel by bus to and from the Cumberland Extended Care and Rehab nursing home on Friday, August 8th.
____________________________________________________________________
Parent Signature Date