Vacation Bible School – Holy Cross Lutheran Church

Information for the 2017 Vacation Bible School coming soon!

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Child's First Name *

Child's Last Name *

Nickname

Date of Birth *

Current Age *

Grade Completed *

Parent's First & Last Name *

Address *

Phone *

In Case of Emergency Please Contact (Name and Relationship to Child): *

Phone Number of Emergency Contact *

Who will be dropping off your child? *

What is his/her relationship to your child? *

Who will be picking up your child? *

What is his/her relationship to your child? *

Health History (please list all that apply): frequent colds, seizure disorder, stomach upsets, diabetes, motion sickness, asthma, emotional upsets, sleep disturbances, physical disability, learning disability, behavioral disability, vision (glasses, contact lenses), hearing disability

If Yes, please list

If yes, please explain:

Any disabilities, please explain

Holy Cross Lutheran Church Perpetual Photo and Video Waiver

I am aware that pictures and/or videos of my child/youth may be taken at various events and programs hosted by Holy Cross Lutheran Church including, but not limited to: Sunday school, service, Youth Group Functions, and Vacation Bible School. I am aware and agree that these pictures and/or videos may be posted to social media sites or Holy Cross’ website. These pictures and/or videos will not be captioned with my child/ youth’s name. The pictures and/or videos will be used for the purpose of illustrating and promoting the activities of the church. I further understand that photos and/or videos may be posted to media sites by individual participants and these photos are outside the control of Holy Cross. Pictures and/or videos posted to the church’s website are considered the property of Holy Cross and may not be sold or reused without the expressed consent of the church administrators.

I have special concerns or requirements regarding photography &/or videography of my child/youth and agree to contact any Holy Cross administrators in advance of each event or program. The youth will be specially identified during the event indicating the youth may not be photographed by representative(s) of Holy Cross Lutheran Church.