VBS 2016: God's Terrific Trail Mix

Complete one (1) form per family. If you have more than three (3) children, please complete a second form.

FAMILY INFORMATION
Parent/Guardian Last Name *
Parent/Guardian First Name(s) (Example: Dan and Rebekah) *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Primary Phone
(number at which we are most likely to reach you) * - (###) - ### ####
Alternate Phone
(in case we can't reach you at your primary number) - (###) - ### ####
Primary Email
(email address to which we can send important information) *
CHILD PARTICIPANTS
Child's Name First Last
Grade Completed
Child's Name First Last
Grade Completed
Child's Name First Last
Grade Completed
Allergies/Health Concerns (Specify child. If none, enter "none.") *
YOUTH HELPERS
I have completed at least 6th grade and would like to be a helper.
Helper Name First Last
Grade Completed
Helper Name First Last
Grade Completed
EMERGENCY INFORMATION
Emergency Contact * First Last
Emergency Contact Relationship to Child/Children *
Emergency Contact Phone * - (###) - ### ####
Alternate Pick-up (authorized to transport child/children) * First Last
Alternate Pick-up Phone
(number at which we are most likely to reach this person) * - (###) - ### ####
Alternate Pick-up Relationship to Child/Children *
CONSENT FOR USE OF PHOTOS
I give my consent for Calvary Lutheran Church to use photos of my child/children for publicity purposes including, but not limited to website, newsletter, bulletins, bulletin boards and brochures. * Yes No