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VBS Online Registration


 

 Vacation Bible School
 
God's Gardeners:
Reduce, Reuse, Recycle, and Respond


Location:
Saint Andrew's Lutheran Church
2650 148th Avenue SE
Bellevue, WA  98007


Monday, July 9 - Friday, July 13, 2018
9:00 am - 12:00 noon
 
For Youth who are 4-years-old through entering 7th grade


Vacation Bible School is co-hosted by:
Our Savior Lutheran Church
Issaquah
Saint Andrew's Lutheran Church
Bellevue
 
Programs for 4-year-olds through entering 7th grade
  • 4-year-olds: Birthdate between 9/1/2013 and 8/31/2014 (for VBS 2018)
  • Students entering 5th, 6th, and 7th grade will be involved in VBS Camp and will be leaving Saint Andrew's to various places in the area (transportation provided.)
    Note: A Camp Release is required for 5th, 6th, and 7th graders. Complete the "STUDENT RELEASE for VBS CAMP" section at the end of this form.

 COST    Before July 1, 2018 After July 1, 2018
   4-year-olds through 4th grade  $ 15 $ 20  
   Camp (5th through 7th grade)  $ 25 $ 35 
   Family Maximum  $ 35 $ 45 
  Financial assistance available upon request;
contact Director of Discipleship Ministries
Emily Harrow, 425-746-2529 or Emily@SALChome.org
   


Family Information
  Mother/Legal Guardian 1  Father/Legal Guardian 2 
First and Last Name 
Home Phone
Work Phone    
Cell Phone
Email    
Address    
City    
Zip     
People who have my permission to pick up my child/children from Vacation Bible School:  

Family Emergency Information
Emergency Contact 1  Name   Phone   Phone  
Emergency Contact 2  Name    Phone  Phone
Physician  Name   Phone    Preferred Hospital
Insurance Carrier  Company Name   Policy/Group #    
MEDICAL RELEASE: In the event of an emergency where medical treatment is necessary, I give permission to the church sponsors to seek appropriate medical treatment for ANY CHILD NAMED BELOW after every reasonable effort has been made to contact the parent(s) and emergency contact person(s) identified. 

Complete the information below for each child in your family, up to five children.

Student 1 Information

First and Last Name   
Birth Date  

Grade in Fall 2018

Known Allergies Food Allergies    Medicine Allergies  
       
 
If pre-school age, identify group experiences
If the student attends Sunday School, please state where
Please list friends of the student who are attending VBS and are in the same grade
PHOTO RELEASE
I give permission for individual or group photographs, video footage, or sound recordings of the CHILD NAMED ABOVE to be used, free of compensation, by Saint Andrew's Lutheran Church, Our Savior Lutheran Church, Shepherd of the Hills Lutheran Church, the Northwest Washington Synod, and the Evangelical Lutheran Church in America for historical and/or promotional purposes and in publications, including, but not limited to, newsletters, emails, websites, blog pages, bulletin boards, other church and/or Lutheran publications, and on social networking sites (such as Facebook, Instagram, etc.)
 Photo Permission Given
 Photo Permission Denied


Student 2 Information

First and Last Name   
Birth Date  

Grade in Fall 2018

Known Allergies Food Allergies    Medicine Allergies  
If pre-school age, identify group experiences
If the student attends Sunday School, please state where
Please list friends of the student who are attending VBS and are in the same grade
PHOTO RELEASE
I give permission for individual or group photographs, video footage, or sound recordings of the CHILD NAMED ABOVE to be used, free of compensation, by Saint Andrew's Lutheran Church, Our Savior Lutheran Church, Shepherd of the Hills Lutheran Church, the Northwest Washington Synod, and the Evangelical Lutheran Church in America for historical and/or promotional purposes and in publications, including, but not limited to, newsletters, emails, websites, blog pages, bulletin boards, other church and/or Lutheran publications, and on social networking sites (such as Facebook, Instagram, etc.)
 Photo Permission Given
 Photo Permission Denied


Student 3 Information

First and Last Name   
Birth Date  

Grade in Fall 2018

Known Allergies Food Allergies    Medicine Allergies  
If pre-school age, identify group experiences
If the student attends Sunday School, please state where
Please list friends of the student who are attending VBS and are in the same grade
PHOTO RELEASE
I give permission for individual or group photographs, video footage, or sound recordings of the CHILD NAMED ABOVE to be used, free of compensation, by Saint Andrew's Lutheran Church, Our Savior Lutheran Church, Shepherd of the Hills Lutheran Church, the Northwest Washington Synod, and the Evangelical Lutheran Church in America for historical and/or promotional purposes and in publications, including, but not limited to, newsletters, emails, websites, blog pages, bulletin boards, other church and/or Lutheran publications, and on social networking sites (such as Facebook, Instagram, etc.)
 Photo Permission Given
 Photo Permission Denied


Student 4 Information

First and Last Name   
Birth Date  

Grade in Fall 2018

Known Allergies Food Allergies    Medicine Allergies  
If pre-school age, identify group experiences
If the student attends Sunday School, please state where
Please list friends of the student who are attending VBS and are in the same grade
PHOTO RELEASE
I give permission for individual or group photographs, video footage, or sound recordings of the CHILD NAMED ABOVE to be used, free of compensation, by Saint Andrew's Lutheran Church, Our Savior Lutheran Church, Shepherd of the Hills Lutheran Church, the Northwest Washington Synod, and the Evangelical Lutheran Church in America for historical and/or promotional purposes and in publications, including, but not limited to, newsletters, emails, websites, blog pages, bulletin boards, other church and/or Lutheran publications, and on social networking sites (such as Facebook, Instagram, etc.)
 Photo Permission Given
 Photo Permission Denied


Student 5 Information

First and Last Name   
Birth Date  

Grade in Fall 2018

Known Allergies Food Allergies    Medicine Allergies  
If pre-school age, identify group experiences
If the student attends Sunday School, please state where
Please list friends of the student who are attending VBS and are in the same grade
PHOTO RELEASE
I give permission for individual or group photographs, video footage, or sound recordings of the CHILD NAMED ABOVE to be used, free of compensation, by Saint Andrew's Lutheran Church, Our Savior Lutheran Church, Shepherd of the Hills Lutheran Church, the Northwest Washington Synod, and the Evangelical Lutheran Church in America for historical and/or promotional purposes and in publications, including, but not limited to, newsletters, emails, websites, blog pages, bulletin boards, other church and/or Lutheran publications, and on social networking sites (such as Facebook, Instagram, etc.)
 Photo Permission Given
 Photo Permission Denied
  

STUDENT RELEASE for VBS CAMP (Students in Grades 5-7)
 
List Students in Grades 5-7:
First and Last Name 
First and Last Name 
First and Last Name 
First and Last Name 
First and Last Name 
STUDENT RELEASE for VBS CAMP
I give permission for ALL CHILDREN NAMED ABOVE who are in grades 5, 6, and 7 to participate in Vacation Bible School, hosted by Saint Andrew’s Lutheran Church and Our Savior Lutheran Church, and all field trips associated with this event on July 9-13, 2017 from 9:00 am to 12:00 noon Monday through Friday.
I understand that my child will be transported by van for such trips and will be driven by a volunteer from the Vacation Bible School program.
 
As parent or legal guardian, in the event of an emergency where medical treatment is necessary, I give my permission to the adults in charge to seek appropriate medical treatment after every reasonable effort has been made to contact the person identified in this registration from. In the event it becomes necessary for a staff member of Vacation Bible School to obtain emergency care for my child, I understand that neither they nor the churches assume financial liability for expenses incurred due to an accident, injury, illness and/or unforeseen circumstances.
 
 

RELEASE:

Submitting this on-line form is the equivalent of signing a paper registration form. 
 Agree
 Disagree

  Press "Submit" to send information to Saint Andrew's Lutheran Church and go to the payment screen