Bethel's VBS!

36 N. Grant Street
Westmont, IL 60559
630-968-3232

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:. VACATION BIBLE SCHOOL

VBS ONLINE REGISTRATION

VBS Registration

PLEASE DO NOT USE THE "ENTER KEY" TO MOVE BETWEEN FIELDS! USE THE "TAB KEY" TO ADVANCE THROUGH THE FORM AND USE "SHIFT AND TAB KEY" TOGETHER TO GO BACK THROUGH THE FORM!!!

Last Name:
1st Child's Name:
Age:
Grade Completed:
Allergies/Medical Limitations:

2nd Child's Name:
Age:
Grade Completed:
Allergies/Medical Limitations:

3rd Child's Name:
Age:
Grade Completed:
Allergies/Medical Limitations:

4th Child's Name:
Age:
Grade Completed:
Allergies/Medical Limitations:

Parents' Name:

Address 1:
Address 2:
City:
State:
Zip:
Home Phone:
Alternate Phone:
Email Address:

Emergency Contact:
Relationship to Child(ren):
Home Phone:
Alternate Phone:

Family Doctor:
Phone:

Home Church:
How did you hear about our VBS?

        I hereby enroll and give permission for my child to participate in the planned activities of Vacation Bible School (VBS) at Bethel Lutheran Church in Westmont, IL. I understand that I am responsible for transportation to and from VBS each day.

        The above health history is correct as far as I know and the child(ren) described has/have permission to engage in all VBS activities except as noted. In the event I cannot be reached in an emergency, I hereby give permission to the medical personnel selected by the VBS director to order X-rays, routine tests, treatment, hospitalization and necessary related transportation for my child(ren) until such time as I am available.

        Photograph release: I understand that unless specifically stated in writing at the time of registration, photos/slides/videotaping of my child(ren) may be taken. I realize that our right to privacy will be protected in all photographs and publications of the VBS activities. I understand that no personal information other than name, hometown and congregation will be released under any circumstance and this meets my approval.

Signature of Parent or Guardian:

Date:

* If registering online, please enter name in signature box. This will serve as your signature.

* Please note that handheld electronic games, CD players, iPods etc. are not allowed at VBS! *

Thank you for your cooperation with this.

Please Complete Sign Out Authorization

List all who are authorized to sign out your child(ren):
    (We will assume that both mom and dad can sign out child(ren) unless otherwise stated.)

Permission to walk or bicycle home?:   Yes     No

Additional information/comments: