Child's Name (first and last)*
(2019-20 school year)*
Parent Name (first and last)*
Parent Name (first and last)
Primary Phone Number*
Second Phone Number
Home Email Address*
Do you have a home church?*
If yes, what church?
Would you like more information about Living Water?
Name of Emergency Contact (if parents cannot be reached)*
Phone Number for Emergency Contact*
Relationship of Emergency Contact to Child(ren)*
Name of Second Emergency Contact
Phone Number for Second Emergency Contact
Relationship of Second Emergency Contact to Child(ren)
Do any of the children have allergies, food/diet restrictions, or any other medical conditions? If yes, please list the child's name and describe the allergy or condition (including the severity and the reaction).
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.*
Photographs of the children may be taken during VBS. Photographs may be used
--In church publications, including by not limited to, weekly bulletins or monthly newsletters
--Displayed within the church building, including but not limited to, bulletin boards or digitally displayed
--On the web, including but not limited to, the church Facebook page or the church website.
Children's names, first or last, will not be used with the images.
I hereby give permission for my child to be photographed at VBS. I understand and agree to allow my child's image to be used as stated above.
Living Water Lutheran Church has my permission to use photographs of my child(ren) in church publications.*
Living Water Lutheran Church has my permission to use photographs of my child(ren) displayed in church.*
Living Water Lutheran Church has my permission to use photographs of my child(ren) used on the web.*