Child's Information

Child's First Name*

Child's Last Name*

Grade Completed in June 2024*

Date of Birth*

Age*

Allergies / Special Concerns

Optional

Register an Additional Child

Child's First Name*

Child's Last Name*

Grade Completed in 2024*

Date of Birth*

Age*

Allergies / Special Concerns

Optional

Register an Additional Child

Child's First Name*

Child's Last Name*

Grade Completed in 2024*

Date of Birth*

Age*

Allergies / Special Concerns

Optional

Register an Additional Child

Child's First Name*

Child's Last Name*

Grade Completed in 2024*

Date of Birth*

Age*

Allergies / Special Concerns

Parent / Guardian 1

Name*

Email

Employer*

Phone 1*

Phone 1 Type*

Phone 2

Phone 2 Type

Address*

Street Address City State ZIP Code

I Would Like to Volunteer*

Yes
No

Parent / Guardian 2

Name

Email

Employer

Phone 1

Phone 1 Type

Phone 2

Phone 2 Type

Address

Same as Parent / Guardian 1

Street Address City State ZIP Code

Form of Payment*

Online (Go to the Giving tab of our website)
Check
Cash

Cost for the week is $40 per child. Please select your form of payment

Pickup Procedure

On most occasions, my child/ren will be dropped off & picked up by the following person/s:*

(If applicable) My child/ren may NOT be released to the following person/s (information is confidential):

For the safety and well being of your children, we ask that ALL CHILDREN be picked up by one of the above persons inside the church after VBS in the designated area. We appreciate your cooperation.

Medical and Liability Release

Parent / Guardian Authorization*

I, the parent or guardian of the previous named registered child/ren participating in educational and event ministry sponsored by Good Shepherd Lutheran Church in Inver Grove Heights, Minnesota, do hereby state that said child/ren are physically and medically able to participate in said activity. I do hereby release and discharge Good Shepherd Lutheran Church and its authorized representatives and staff from all liability of any kind and character upon any claim, demand, or cause of action, which might be asserted in behalf of said minor and/or myself against Good Shepherd Lutheran Church, representatives, or staff. Furthermore, in the event of an accident, if said staff or representatives are unable to contact the undersigned, I hereby grant permission to said staff or representatives to administer first aid, and/or have medical personnel (911 or hospital) to treat my child/ren in the event of any emergency in which I cannot be reached.

I give permission to:

Use photographs of the student listed above on the Good Shepherd Lutheran Church social media / website.

Good Shepherd Lutheran Church

Calendar

VBS – God’s Wonder Lab

June 13, 2022 @ 9:00 am - 12:00 pm

VBS Registration (June 10-13, 2024)

Child's Information

Parent / Guardian 1

Parent / Guardian 2

Pickup Procedure

Medical and Liability Release

Details