EmailMe Form - Leelanau VBS 2019 Registration

Leelanau VBS 2019 Registration - Deadline June 12

**Fun for Children Ages 4 - 12**
"GOD is Incredible, So Are YOU!"

June 17th - June 20th
*Monday - Thursday (9am - 12pm)
$10 Registration fee per child; $25 per family; Checks: "Leelanau VBS"
Bring on the first day of VBS!

Sponsoring Churches:
- Suttons Bay Congregational Church
- Immanel Lutheran Church
- St. Michael's Church of Suttons Bay
- Keswick United Methodist Church of Suttons Bay

Host for 2019: Keswick United Methodist Church of Suttons Bay
3376 S. Center Hwy, Suttons Bay
(231)271-3755

Bring Daily:
- Appropriate clothes for outdoor weather.
- Offerings: Baby diapers/wipes for Leelanau Baby Pantry or Canned/dry food items/monetary donations to Leelanau Christian Neighbors
-Note: No Lunch; Snack Provided.

Thursday June 20th is "Family Celebration Picnic Day" at 12 noon for kids and their families.
Please Join Us!!

Family Name *
Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Contact Phone *
### - ### - ####
Email *

Confirm
Guardian/Parent Name *
First Last
1st Child's Name *
First Last
Grade Entering in September *
Age *
T-Shirt Size *
2nd Child's Name
First Last
Grade Entering in September
Age
T-Shirt Size
3rd Child's Name
First Last
Grade Entering in September
Age
T-Shirt Size
Would you like to volunteer in some capacity? *
If YES: You will need to fill out the Volunteer Form Link located next to the Registration Link.
Emergency Contact *
First Last
Phone *
### - ### - ####
Relationship to child *
Please select YES if you are okay with VBS publishing your child's picture (Photo disclaimer) *

Yes No

Please Check One
Insurance Information *

Carrier or Plan

Group #
Name of Family Physician *
Physician's Phone *
### - ### - ####
Physician's Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Name of Family Dentist
Dentist Phone *
### - ### - ####
Does the participant have any activity restrictions? Has the participant had any recent illness, injury, or infections disease? (If yes, please explain.) *
Allergies: List all known; medical, food, etc... *
Signature of Parent/Guardian (By typing your name your are signing this form electronically) *
Clear
This health history is correct and complete as far as I know. The person described has permission to engage in all activities except as noted. I give permission to the VBS leaders to provide routine health care, administer prescribed medications, and seek emergency medical treatment. I agree to the release of any records necessary for insurance purposes. I give permission to the VBS leader to arrange necessary related transportation for my child I hereby give permission for the VBS leader to administer over the counter medications as deemed necessary except as noted in the allergy box above.
I understand and agree to abide by any restriction placed on my child's participation in camp activities.
Important Information!

For the security and safety of all your children, please bring in and pick up your child inside the church area of VBS.

We are expecting you will pick up your child. If this is not going to happen please indicate below who will be picking up your child.
Any Questions or Comments? Type here or you may contact Lee Grant 231-633-0774 or Nicki Hursey 231-499-6273. Thank you!

	Yes	No
Please Check One


Carrier or Plan
Group #

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