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Please Join Our
Sponsored by:
Gloria Dei, St. Andrew & Zion Lutheran Churches

FREE & Open to ALL children ages 3 to going into 6th grade
JULY 22nd - 26th, 2019
5:30pm - 8:00pm

(includes dinner for your child)
At St. Andrew Lutheran Church
1125 Stafford Ave, Bristol, CT 06010
Please fill out the following form to register for Vacation Bible School
(For more information, please contact the St. Andrew Church office)
Parent / Guardian Name:
Email Address:
Phone Number:
Address (Street, City, State):
Emergency Contact Info (Name, Phone, Address):
Is another adult authorized to pick up your child?:
If yes, type name:
How did you hear about VBS?:

Child(ren)'s Name(s) Age Grade entering this fall T-Shirt size Allergies / Other Needs
Photo Release
I     (select one) permission to St. Andrew, Glorei Dei and Zion Lutheran Churches of Bristol, CT to use the image of my child/ren in slide shows, video presentations, the churches websites, television, newspapers, and other publications. No name would appear with the image.
Emergency Medical Attention
I     (select one) counselors and staff from St. Andrew, Glorei Dei and Zion Lutheran Churches of Bristol, CT to seek emergency medical attention for my child/ren named above, should the need arise, if I or my emergency contact person are unreachable by phone.

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