VACATION BIBLE SCHOOL REGISTRATION
JUNE 19-23, 2017
9:00 AM – 12:00 NOON

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Family Last Name:*
Primary Phone #:*
Street Address:*
City, State, Zip:*
Email Address:*
Parent/Guardian:*
Secondary Contact:
Secondary's Relationship to Child(ren):
Emergency Contact:*
Emergency Contact Phone #:*

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EARLY REGISTRATION: $20.00 thru May 10th, 2017 ($50 maximum reg. fee per family)
REGISTRATION: $25.00 after May 10th, 2017 ($50 maximum reg. fee per family)
VBS T-Shirts: Included with registration!
Registration includes FREE Music CD for every Family

Payment from Paypal transaction will show from St. John’s Lutheran Church

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Number of children registering:
Child's Name
First Name:
Last Name:
Date of Birth: (mm/dd/yyyy)
T-Shirt Size (Free):
Grade just completed:
Age:
Allergies:
Special Needs:

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Are you a St. John's member?:
YesNo
If No:
We are interested in knowing more about St. John's other ministries.
We have no church home and are interested in learning about membership at St. John's.

Are you Crosspoint member?:
YesNo
If No:
We are interested in knowing more about Crosspoint's other ministries.
We have no church home and are interested in learning about membership at Crosspoint.

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Liability Release: I voluntarily indemnify and hold harmless the Church, Board, Employees and volunteers, their respective officers, and agents from any and all liability, loss, personal injury, sickness or death, as well as property damages, costs, or expenses of any natures (including attorney’s fees) whatsoever arising out of my child(ren)’s participation in Vacation Bible School at St. John’s Lutheran Church in Algonquin, IL, from June 19-23, 2017 and which do not arise out of the negligent acts or omission of an officer, employee, and agent of the church, while acting in the scope of their employment or duties for the church.

* Yes, I accept/acknowledge the Liability Release.

Photo Release: By registering for VBS, you grant permission for St. John’s Lutheran Church to photograph your child(ren) while they are attending the June 19-23, 2017 VBS program, to possibly be used for publication in the church bulletin, the church website, on bulletin boards and/or for slide presentations.

* Yes, I accept/acknowledge the Photo Release.

Medical Release: As a parent and/or guardian, I authorize the treatment by a qualified medical doctor of the following minor(s) in the event of a medical emergency while attending the June 19-23, 2017 VBS program at St. John's Lutheran Church.

* Yes, I accept/acknowledge the Medical Release.

Family Physician:
Physician Phone #:

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Click submit to continue to PayPal. Your total registration fee is:
$20