Redeemer Lutherhan Church

Praising God, serving neighbors with Christ at the center!

Vacation Bible School

Kids learn about God’s plan of salvation from creation to cross with five spectacular Bible lessons.

Name
Grade Completed
Birthday
Age
Parent / Guardian 1
Parent / Guardian 2
Address
City
Zip
Home Phone
Alt. Phone
Email
Emergency Contact
Relationship to Student
Home Phone
Alt. Phone
Food Allergies / Medical Problems
Family Doctor
Doctor Phone
Siblings Attending VBS (Names & Ages)
Church Affiliation
Church Membership At
Brought By

You must sign your child in and out at the classroom each day.

Train up a child in the way he should go: and when he is old, he will not depart from it. Proverbs 22:6

Authorization to Consent to Medical and Dental Care

I / We, the parent(s) and/or natural guardian(s) of do authorize my child's VBS Event Leader (and/or any other adult appointed or designated by him/her) to consent to medical, surgical, and dental care for child, (a) consent to any diagnostic tests, medical, surgical, or dental procedure or treatment as may be considered therapeutically necessary by the physician, surgeon, dentist, or other health care personnel providing care for child, and on my/our behalf, to employ physicians, surgeons, dentists, nurses, and other health care personnel as may be deemed necesary for such minor child, (b) admit such minor child to any hospital, clinic, emergency room, laboratory, or other health care or diagnostic facility for examination, treatment, surgery, or care and (c) sign all necessary consents and authorizations. It is understood that this authorization is given in advance of the occurence of any condition or situation which would necessitate any such medical, surgical, or dental care being required but is given to provide authority to obtain such care if it should be required. It is understood that every effort should be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached.

Typing Your Name Constitutes Your Signature
9/25/2018

I release Redeemer Lutheran Church, Interlochen Michigan, their agents and servants, successors and assigned, directors, trustees, officers, employees, and other representatives from any and all damages and causes of action whether at law or in equity which the before mentioned minor may have as a result of their participation in and attendance at Vacation Bible School. Furthermore, I do expressly stipulate, and agree to indemnify and hold forever harmless the above named agencies.

Typing Your Name Constitues Your Signature
9/25/2018