VBS 2025 Registration Parents Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Emergency Contact * Name & number of person to contact in the event of an emergency. First Name Last Name Emergency Phone * (###) ### #### Relation to Camper * Parent, grandparent, family member, Nanny/Babysitter, etc. Camper 1 * First Name Last Name Date of Birth MM DD YYYY Gender Male Female Allergies Yes No What is your child allergic to: Camper 2 First Name Last Name Date of Birth MM DD YYYY Gender Male Female Allergies Yes No What is your child allergic to: Camper 3 First Name Last Name Date of Birth MM DD YYYY Gender Male Female Allergies Yes No What is your child allergic to: Line Consent * Our Child has permission to take part in all Day Camp activities led by Mt. Cross Lutheran Camp and Good Shepherd Lutheran Church. We agree that the Camp, Church, and their personnel will not be held responsible for accidents arising therefrom. I give Camp and Church personnel permission to seek medical treatment for my child in case of injury or illness. I also give permission for photos, video, and electronic images to be taken of me or my child and used by the Camp or Church for promotional purposes without compensation, inspection or approval. Confirm Consent Verify Consent * Date of Consent * MM DD YYYY Yippeeee! You have completed registration for VBS from July 21st to 26th at Good Shepherd.
