July 6-10, 2026

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1. Student name:

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2. Address:

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3. Nickname

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4. Age in July 2026

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5. Gender:

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6. Grade just completed:

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7. Home Church (if applicable)

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8. Please list any medical/health issues, allergies, special needs or activity limitations:

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9. Parent/Guardian 1 name:

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10. Parent/Guardian 1 contact phone number:

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11. Parent/Guardian 2 name:

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12. Parent/Guardian 2 contact phone number:

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14. Emergency Contact Name:

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15. Emergency contact phone number:

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16. Medical Release: I give my permission for the VBS staff to administer basic First Aid to my child named above in the event of an injury. I understand the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be my financial responsibility.

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17. Photo Release: I give my permission for the VBS staff and St Mark Lutheran Church to copyright and use photographs/videos taken at VBS of my child named above, in any manner or form for any legal purpose at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

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18. Completed by:

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