Mt. Olive VBS

Registration Form

Student's Name

First Name

Last Name

Grade in Fall

Enter Pre-K, K, or numerical grade.

Parent's / Guardian's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Food Allergies

List any food allergies or sensitivities.

Medical Concerns / Other Allergies

None

Yes

If yes, please explain:

Emergency Contact Name

First Name

Last Name

Emergency Contact Number

By checking the box below, I hereby grant permission for Mt. Olive Lutheran Church to record pictures or videos of my child, named above, while on the church property or at a church-sponsored event including, but not limited to Vacation Bible School. I also give permission for Mt. Olive Lutheran Church to use these images or videos in church print and online publications including church websites and social networks.

I provide consent.

Registration submitted by

Name