At JESUS COUNTY FAIR, children will learn about the Fruit of the Spirit: Love, Joy, Peace, Patience and Kindness by participating in worship, service, games, crafts, science and other activities.

This fun-filled Vacation Bible School is for everyone between the ages of 4yrs (potty trained) and 11yrs old or PreK-6th grade.

The children will also learn about mission through special offerings to support our adopted compassion child, Ephraim, who uses our financial support to further his education, seek proper healthcare and learn critical life skills.

Child’s Name _______________________________________________________________________________________________________________ Birthday____________________________________

Grade Completed____________________________________ Age____________________

Parent/Legal Guardian_____________________________________________________________________________________________________

Relationship to Child_______________________________________________________________________________________________________ Daytime Phone Number________________________________________

Alternate Number_________________________________________ Mailing Address_____________________________________________________________________________________________________________

Anyone else who has permission to pick up the child?____________________________________________________________________

How did you hear about VBS at St. James?________________________________________________________________________________ Do you have a church home? If yes, where?_______________________________________________________________________________

Photo Release:
I hereby grant to St. James Lutheran Church, and to its employees, agents, and assigns the right to photograph my dependent and use the photograph and/or other digital reproduction of their likeness for publication process,
whether electronic, print, digital or electronic publishing. I am the custodial parent/guardian of the above child able to assign such rights. Signature:___________________________________________________________________________________________

I do not give permission for the above listed child to be photographed during Vacation Bible School 2019 at St. James Lutheran Church. Signature:________________________________________________________________________________________

My Family Registration Fees:
One registration form per child, place totals for family cost on top form. One Child $30, Two Children $55, Max Per Family $70. There are scholarships available, contact the church office by July 15th.
Make checks payable to St. James, Memo: VBS 2019.
How many children in your household are being registered?_______________________ Total paid?_________________________

Medical Information & Release: Physician:___________________________________________________________________________________________________________________ Medical Insurance Company:_______________________________________________________________________________________________

List Medical Conditions and/or Limitations:_______________________________________________________________________________
______________________________________________________________________________________________________________________________ Allergies (Including food, medication, etc.):_______________________________________________________________________________

I/we the undersigned, parents/legal guardians, of a minor, do hereby authorize St. James Lutheran Church and/or adults designated as agent for St. James, to consent to any diagnostic procedure deemed necessary by a medical professional for the purpose of medical diagnosis or treatment and hospital care or release or service under the general or specific supervision of any physician and surgeon licensed under the supervision of the Medicine Practice Act of the state of California or any state within the United States of America, or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given as specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his/her best judgment, may deem advisable, to protect the life and health of said minor.
In consideration of the benefits to be derived from the aforesaid outings, (I)/(we), hereby voluntarily waive any claim against St. James Lutheran Church, and the owner and driver of any vehicle in which my (our) child is to receive transportation to/from/during any of said activities.
The authorization is given pursuant to provisions of Sec 25.8 of the Civil Code of California, and shall remain effective until 8/5/19 unless sooner revoked in writing before that date.

Signature:________________________________________________________________________________________ Date:____________________
(One signature represents both parents/legal guardians)

St. James Lutheran Church Vacation Bible School 2500 Shasta View Drive Redding, CA 96002