Child’s Name: _____________________________________ Age: _______
Next school grade in Fall ‘15: ____ Email: __________________________
Address: ______________________________________________________
City: ____________________________ State: _______ Zip: ____________
Phone: ________________________________ Birth Date: _____________
Shirt size (youth sizes): _______ Brought by: _________________________
Parent’s Name(s): ______________________________________________
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When: July 6-9, 9am-12noon
Where: Redeemer Lutheran Church
Who: Children ages preschool 3 (must be 3 by July 1, 2015
and potty trained) through entering 6th grade in the Fall 2015
Cost: $10 (helps offset shirt & supply costs)
Howdy Campers! It’s time for Vacation Bible School (VBS)! At
VBS, we’ll gather at Camp Discovery to learn about Jesus and
how He works through us a super-BIG plan. Shout it from home
to camp, as we trek out for an amazing week! Don’t miss the
WILD GAMES, COOL SONGS, FUN SKITS, and SUPER SNACKS.
Question? Want to sign up? Volunteer? Contact the church
office (573-364-7071) or visit RedeemerRolla.org. We hope
to see you there!
Redeemer Lutheran Church
1701 Hwy 72 E, Rolla, MO 65401  573-364-7071
[email protected]
Home Church: _____________________________ City: ______________
Emergency Contact Name: ____________________________________
Phone: ______________________ Relationship to child: ______________
Medical or other allergies we should be aware of: _________________
______________________________________________________________
______________________________________________________________
I, the parent/guardian of this registered child hereby give permission for him/her to
participate in Vacation Bible School at Redeemer Lutheran Church (Rolla, MO). I consent to his/her participation in the activities planned for this event and certify that he/
she is physically able to engage in the event. I hereby grant to the leader in charge of
the group the right to make emergency medical decisions for my child in the event I
cannot be reached. I understand I/we release and forever discharge Redeemer Lutheran Church, its staff and adult chaperones from any and all claims, demands,
actions, or causes of action, past, present or future arising out of any damage or injury
while participating in this event. I am at least 18 years of age, I understand the above
statement and am competent to execute this agreement.
Please check “no” if you do not wish for Redeemer Lutheran Church (Rolla, MO) to
use for publishing or showing minor child’s still or moving image.
Parent/Guardian Signature: _____________________________________
Print Name: ______________________________ Date: _______________
In-House Information:
Cash | Check (#_______) Registration Emerg. Info Shirt