VBS Registration & Permission Form

Parent/Guardian First & Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

List Child/Children Name & Age

Medical Conditions: Condition(s) that we should be aware of (allergies, medications, etc)?

Treat=Administer simple first aid. Ex: provided medication by parent, epi pen, first aid spray/band-aids. Treatment does not include anything beyond simple first aid. In case of actual emergency, the parent and authorities would be contacted immediately.

Parent Signature: I have read & agree to definition of "treat." Type you First and Last name if you agree.

Emergency Contact Phone Number

Emergency Contact Name

Name & Phone Number of a alternate authorized person (someone other than a parent) to pick up your child. If no one, write NONE.

Snacks

Yes, my child has permission to eat snacks provided at VBS.

No, my child will bring a labeled snack daily from home.

Photography/Video Release (Promo use: church's website/social media)

Yes, you may photograph/video my child and release images.

No, you may not photograph/video my child and release images.

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Submit

Area Hotels

Please call hotels directly and mention "Limitless" with Oct 5-7 dates for discount.

A list of area restaurants will be provided at the conference.

Comfort Inn & Suites
8570 Rock Ridge Dr., Mountain Iron
(218) 741-7411 / 1.7 Miles

Amercinn
5480 Mountain Iron Dr., Virginia, MN 55792
(218) 208-0230 / 3 Miles

Super 8
1080 Industrial Pkwy, Eveleth, MN 55734
(218) 297-0782 / 6.3 Miles

VBS Registration & Permission Form

Area Hotels

Please call hotels directly and mention "Limitless" with Oct 5-7 dates for discount.A list of area restaurants will be provided at the conference.

Please call hotels directly and mention "Limitless" with Oct 5-7 dates for discount.

A list of area restaurants will be provided at the conference.