Side by Side Ministries of

St. Paul ~ St. John Lutheran Church

VBS 2015 Registration Form

Jesus My Superhero
Located at St. Paul Lutheran Church
541 S. Church Rd. Marblehead, Ohio

Vacation Bible School, July 27th July 31st 6PM-8PM

Preschool through 6th grade and families

___________________________
Childs Name

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Date of Birth

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Childs Name

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________
Date of Birth
Age/Grade

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Childs Name

__________
________
Date of Birth
Age/Grade

___________________________
Parent/Guardian Name

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Parent/Guardian Name

__________

_________

Home Phone

Cell Phone

Address (include town)

Home Phone

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Age/Grade

Cell Phone

Address (include town)

_________________________

_________________________

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Primary Emergency Contact

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Secondary Emergency Contact

__________

_________

__________

__________

Home Phone

Cell Phone

Home Phone

Cell Phone

When you arrive each evening, it will be your responsibility to sign your child in
and report who will be picking your child up from Vacation Bible School.

Vacation Bible School July 27th-July 31st, 6:00PM - 8:00PM

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Hospital/Clinic Preference
_______________________________________
Physicians Name

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Phone Number

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Insurance Company

___________________________
Policy Number

ALLERGIES/SPECIAL HEALTH CONSIDERATIONS/MEDICATIONS:

______________________________________________________
____________________________________________________
I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other
medical and/or hospital procedure as may be performed or prescribed by the attending
physician and/or paramedics for my child and waive my right to informed consent of
treatment. This waiver applies only in the event that neither parent/guardian can be reached
in the case of an emergency.

Parents/Guardians Signature

Date

I give permission for my child to attend St. Paul/St. John Lutheran Church VBS activities. I
release St. Paul/St. John and individuals from liability in case of accident during activities
related to St. Paul/St. John Lutheran Church and VBS activities, as long as normal safety
procedures have been taken.
____________________________________

___________

Parents/Guardians Signature

Date

Return application form to St. Paul Lutheran Church:

541 Church Rd., Lakeside-Marblehead, OH 43440
Questions? Contact: Pastor Chris Young (419) 734-1662 OR
Chrissy French (VBS Director) (419) 341-4653

Jesus, Youre My
Superhero!
Vacation Bible School
At St. Paul Lutheran Church
541 S. Church Rd., Marblehead, Ohio 43440

July 27th July 31st 6PM-8PM

*Note VBS time Change for 2015
**Every child should bring a washed and dried white t-shirt to VBS. We will be ironing
on transfers and creating a group t-shirt to wear on Friday!

Make It A Family Night

Options for older kids and adults:
Mon.

Walk & Talk with each other around the church grounds;
plus cemetery scavenger hunt

Tues.

Tour, Sample, and Help with the Community Garden (bring

gloves and tools if you would like to get in the dirt:)

Wed.

Enjoy a cup of coffee/juice and a food demonstration

(with taste samples) from our Daniel Plan group.

Thurs.

Join an outdoor game of dartball! (Or CornHole)

Fri.

Popcorn & Movie Night - Gods Not Dead