Vacation Bible Camp 2023 | St. Mark's Lutheran Church & Preschool

VBC 2023

Registration fee is $45 per student (by filling out this online form, payment will be required the FIRST day of the event (June 26-June 29, 2023). There is currently no online payment option. We will accept cash and checks.

Name of Parents or Guardians/nombre de los padres

Email/correo electronico

Phone/teléfono

Work or Home Phone/teléfono de casa o trabajo

Emergency Contact (name, phone number and relationship)/ contacto de emergencia (nombre, numero y relacion)

Child #1 (Please include allergies/any medicines/grade of kids) / Niño #1 (Por favor incluya alergias / medicinas / grado de los niños)

Child #1: Date of Birth, Height, Weight, Insurance Provider and Policy # / Niño #1: Fecha de nacimiento, altura, peso, proveedor de seguros y póliza #

Child #2 (Please include allergies/any medicines/grade of kids) / Niño #2 (Por favor incluya alergias / medicinas / grado de los niños)

Child #2: Date of Birth, Height, Weight, Insurance Provider and Policy # / Niño #2: Fecha de nacimiento, altura, peso, proveedor de seguros y póliza #

Child #3 (Please include allergies/any medicines/grade of kids) / Niño #3 (Por favor incluya alergias / medicinas / grado de los niños)

Child #3: Date of Birth, Height, Weight, Insurance Provider and Policy # / Niño #3: Fecha de nacimiento, altura, peso, proveedor de seguros y póliza #

Child #4 (Please include allergies/any medicines/grade of kids) / Niño #4 (Por favor incluya alergias / medicinas / grado de los niños)

Child #4: Date of Birth, Height, Weight, Insurance Provider and Policy # / Niño #4: Fecha de nacimiento, altura, peso, proveedor de seguros y póliza #

Child #5 (Please include allergies/any medicines/grade of kids) / Niño #5 (Por favor incluya alergias / medicinas /grado de los niños)

Child #5: Date of Birth, Height, Weight, Insurance Provider and Policy # / Niño #5: Fecha de nacimiento, altura, peso, proveedor de seguros y póliza #

Permissions and Liability

I have read the document above and agree to the terms / He leído el documento anterior y acepto los términos

I/we hereby release St. Mark's Lutheran Church located at 1600 Union Avenue, Fairfield, Calif., its employees and all official representatives of the church and the Evangelical Lutheran Church in America from any liability to the extent permitted by law. / Yo/nosotros liberamos a la Iglesia Luterana St. Mark's ubicada en 1600 Union Avenue, Fairfield, Calif., sus empleados y todos los representantes oficiales de la iglesia y la Iglesia Evangélica Luterana en América de cualquier responsabilidad en la medida permitida por la ley.

I consent/do not consent (YES or NO in text box) to the use of any such audio or visual record of the child named above or me, if I am participating, to be used by agents of the church for church publication or on the church website or social networking sites.

Thanks for registering to our event. See you there! Gracias por registrarse en nuestro evento. ¡Nos vemos!

VBC 2023 Registration fee is $45 per student (by filling out this online form, payment will be required the FIRST day of the event (June 26-June 29, 2023). There is currently no online payment option. We will accept cash and checks.

ST. MARK'S LUTHERAN CHURCH & PRESCHOOL

VBC 2023

Registration fee is $45 per student (by filling out this online form, payment will be required the FIRST day of the event (June 26-June 29, 2023). There is currently no online payment option. We will accept cash and checks.