YOUTH PARTICIPANT REGISTRATION FORM

Thank you for joining us at Ascension Lutheran Church for Operation Restoration VBS! Use this form to register.

Name

First Name

Last Name

Nickname

Date of Birth

YYYY

Upcoming school grade this fall

T-shirt size

Small

Medium

Large

X-Large

Siblings attending VBS

Home congregation (if any)

Please list any allergies (including food allergies) VBS staff should be aware of

Does your child have one or more peers attending VBS who they'd like to be with? If so, list them here:

Parent/Guardian Information

Parent/Guardian 1

First Name

Last Name

Phone

(###)

###

####

Parent/Guardian 2

First Name

Last Name

Phone

(###)

###

####

Emergency Contact Information

In case of emergency, contact person if parent/guardian cannot be reached:

Name

First Name

Last Name

Phone

(###)

###

####

Relationship to participant

Person/people who will pick up participant at the end of the VBS day:

Name

First Name

Last Name

Phone

(###)

###

####

Throughout VBS, we may take videos or photos of the kids in action. We only share photos and videos of kids who have signed Media Release Form. Check here if you have signed the Media Release Form for your child.

I have signed the Media Release Form for my child

We are so excited to have your child at VBS! Is there anything you would like us to know so we can make sure they have the best week possible?

This year we have an adult component for our program, will you be attending?

Yes

Have you filled out the form for adult participants?

Yes

E-signature

To submit your E-signature, type your full name in the box below