VBS Registration
ST. JAMES LUTHERAN CHURCH
VACATION BIBLE SCHOOL
JULY 22 THRU JULY 26, 2019
6:00 PM - 8:45 PM   (Light supper at 5:30 PM)
 
REGISTRATION FORM
   (4 years to 6th grade)
 
VBS 2019 – MEDICAL CONSENT AND RELEASE FORM
Permission and authorization is hereby given by the undersigned to staff members (paid or volunteer) of St. James Lutheran Church of Cleveland, OH to administer basic first aid or assistance as may be required in the event of illness or accident on the part of the minor child registered in the Vacation Bible School while he/she/they are involved in Vacation Bible School at St. James Lutheran Church, 4771 Broadview Rd., Cleveland, OH.
 
It is understood that St. James Lutheran Church has no insurance covering medical or hospital costs incurred for said child(ren), and therefore, any cost incurred for such treatment shall be the sole responsibility of the parent(s)/legal guardian(s).  In no event will St. James Lutheran Church, its Pastor or staff be held liable for any accident or illness, nor shall they be held liable for any first aid rendered.
 
Name of Child:_________________________________________________________________________
Current Age: ______    School Grade Completed: _______  Date of Birth: __________________________
Parent(s)’ Name: _______________________________________________________________________
Address: _____________________________________________________________________________
Phone Number: (home) __________________________    (cell #s): _______________________________
E-mail address: ________________________________________________________________________
Emergency Contact Person & Phone Number: ________________________________________________
Person to Whom Child May Be Dismissed or Released to Other than Parent:
___________________________________   (relationship to child)   ______________________________
Alternate Person to Whom Child May Be Dismissed or Released to Other than Parent:
___________________________________   (relationship to child)   ______________________________
Allergies or Special Needs: ______________________________________________________________
Home Congregation: __________________________________              Child Baptized: ___ Yes  ___ No
 
______________________________________                                           _________________________
         Signature of Parent/Guardian                                                               Date

Please return to:
                                                                                                
St. James Lutheran Church                                                      
4771 Broadview Rd., Cleveland, OH 44109                         
216-351-6499