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Home
About Us
>>
Virtual Tour
What We’re About
Our Beliefs
Our Mission
Our Staff
Services
>>
Services Schedule
Online Live Stream
All Media
Childcare
Connect
What We Do
>>
Our Ministries
Spirit Newsletter
Worship & Music
Calendar
Announcements
Media
Preschool
Media
Select Media Below
All Media
Radio Show: The Eternal Connection
Live Stream
Daily Devotionals
Worship Services
Sermons
Bible Studies
Varied Media
Free Desktop Images
Giving
Contact
Select Below
Contact Us
Prayer Requests
Facility Reservation
Jobs
Leave us a Review
St Mark VBS Signup
Child's Info
Name
(Required)
First
Last
Birthdate
(Required)
MM slash DD slash YYYY
T-Shirt Size
(Required)
T-Shirt Size
XS
S
M
L
XL
Gender
(Required)
Male
Female
What grade are they entering this fall?
(Required)
Home Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
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Delaware
District of Columbia
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Northern Mariana Islands
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Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
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Wisconsin
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Does your child have any food allergies?
(Required)
No
Yes
Please explain
(Required)
Are there any medical issues we need to be aware of?
(Required)
No
Yes
Please explain
(Required)
Name of Family Doctor
(Required)
Doctor's Phone
(Required)
Please list any persons other than the registering parent who may pick this child up from VBS.
(Required)
Parent's Info
Name
(Required)
First
Last
Home Address (if different than above)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Phone Contact
(Required)
Secondary Phone Contact
Primary Email
(Required)
Secondary Email
Consent
(Required)
I hereby give informed and expressed consent for my child to take part in all VBS activities under supervision and agree that VBS personnel/volunteers will not be held responsible for accidents arising therefrom. I authorize designated VBS personnel/volunteers to provide appropriate treatment to my child for injuries and/or illness. I understand that the information from the VBS registration form that I completed may be released to appropriate medical personnel in case of medical emergency. I also understand that the failure to disclose medical, behavioral and/or mental health information in advance may lead to serious consequences for my child while at VBS.
Consent
(Required)
I grant permission to St. Mark Lutheran Preschool & Childcare Center (SMLPSCC) and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium and without restriction. I hereby release SMLPSCC and its legal representatives for all claims and liability relating to said images or video. I also waive my right to any compensation.
Digital Signature
(Required)
Please type your full legal name. This constitutes a legal digital signature.
Volunteer?
Are you able to volunteer?
(Required)
Yes
No
Which day(s)?
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
• Check areas in which you feel comfortable assisting the section leader:
(Required)
Craft
Music
Snacks
Playground Supervisor
Games
Age-level helper (stays with same group of kids all morning)
Skits
Anything!
CAPTCHA
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