This Form Is for Children Attending Vbs Who Are Enrolled in Camp Ohana

THIS FORM IS FOR CHILDREN ATTENDING VBS WHO ARE ENROLLED IN CAMP OHANA.

Hephatha Lutheran Church / Vacation Bible School

July 22-26, 2013 / Event 9:00 a.m.-12:00 p.m.

Participant/Volunteer Registration / Grades K-6th

Sonsurf Beach Bash is a beach-themed camp that allows kids to participate in fun activities with beach/water themes while teaching them lessons from the Bible.

Bring your bathing suit and towel every day – get ready to get wet!!

COMPLETED REGISTRATION with PAYMENT DUE on or before SUNDAY, JULY 7th, 2013,

in order to GUARANTEE FULL PARTICIPATION. COST: $20.00 per CHILD

Please place completed Registration form in VBS envelope in Church office or Day school office. If you have any questions or concerns, please contact Judy Perry, VBS Director, at (714) 777-7167 or , or Jeff Wakefield, Registration Coordinator, at (714) 397-8042 or .

Child #1 Name ______Circle Grade (2013/2014): K 1 2 3 4 5 6

Circle T-shirt Size: Youth - XS (2-4) SM (6-8) M (10-12) LG (14-16) Adult - SM M LG XL XXL

Food Allergies or Medical Problems ______

Child #2 Name ______Circle Grade (2013/2014): K 1 2 3 4 5 6

Circle T-shirt Size: Youth - XS (2-4) SM (6-8) M (10-12) LG (14-16) Adult - SM M LG XL XXL

Food Allergies or Medical Problems ______

Child(ren) May ONLY be Released to One of the Following:

Mother ______Father ______Alternate 1 ______Alternate 2 ______

Home Address ______City ______Home Phone ______

Cell Phone ______Home Church ______Email Address ______

Hephatha Lutheran School Age Care ONLY: I the parent/guardian of the above mentioned child(ren), do hereby authorize the designated leaders of Hephatha Lutheran School Age Care to escort and release the above mentioned child(ren) to the designated leaders of Hephatha Lutheran Vacation Bible School.

Health Information - ALL Items MUST be Completed:

Insurance Company ______Phone ______Policy # ______Group # ______

Child Physician ______Phone ______Child Dentist ______Phone ______

In the event of an emergency, I the parent/guardian of the above mentioned child, do hereby authorize Hephatha Lutheran Church and its designated leaders to consent to any medical and/or hospital care for my child, upon the advice of a licensed physician. It is understood that Hephatha Lutheran Church and its designated leaders will make a reasonable attempt to notify me of such circumstances, as soon as possible. I further agree that Hephatha Lutheran Church and its designated leaders are not legally or financially liable for any claim arising from any consent given in good faith in connection with such diagnosis or advised treatment.

I the parent/guardian of the above mentioned child(ren), do hereby understand that pictures may be taken during the events and activities conducted at Hephatha Lutheran Church, and may be presented in various Church-sponsored media, including, but not limited to the following: pictures, video presentations, internet web pages, brochures, newsletters and newspaper articles.

Signature Parent/Guardian ______Date ______

** Volunteer registration information on back **

If you would like to volunteer for this year’s VBS, we would love to have you! We need volunteers to help with leading or assisting games, teaching Bible lessons, helping with registration, snacks, and more. Please contact Judy Perry, VBS Director, at (714) 777-7167 or , for more information. Thanks!

Name ______

If 18 yrs. or older, please check ___ If under 18, please give age _____

Phone # ______Email ______

T-Shirt Size ______

HEPHATHA LUTHERAN CHURCH / 5900 E SANTA ANA CANYON RD, ANAHEIM, CA 92807 / (714) 637-0887